A Physician's Reflections
Berenson, Robert A.
Hastings Center Report. 1989 Jan/Feb; 19(1): 12-15.
A physician's attempt to hospitalize a 93-year-old patient with Alzheimer's disease illustrates that utilization review (UR) determinations often are based on criteria that apply imperfectly to individual cases; that UR programs are regulatory, not supportive, in design; and that UR outcomes for patients depend inordinately upon the willingness and ability of physicians to become adversarial, rather than upon the merits of the case. Berenson presents and critiques alternative solutions to the problem of health care costs and concludes that the implementation of utilization review should be improved by publication of the criteria used to certify hospitalization and by standardization of procedures to assign lengths of stay. Physicians will best serve their own interests and those of their patients, not by challenging the imposition of accountability restraints, but by holding those paying the bill to high standards for their cost restraint activities. (KIE abstract)
Accountability; Aged; Alternatives; Dementia; Diagnosis; Disease; Economics; Health; Health Care; Health Insurance; Health Maintenance Organizations; Hospitals; Incentives; Insurance; Medicine; Organizations; Patient Admission; Patient Advocacy; Patient Care; Patients; Peer Review; Physicians; Preventive Medicine; Remuneration; Review; Standards;