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Article   |    
Utilization Review: Theory, Practice, and Issues
Jack Zusman
Psychiatric Services 1990; doi:
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Florida Mental Health Institute, 13301 North 30th Street, Tampa, Florida 33612

1990 by the American Psychiatric Association

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Abstract

Utilization review is now carried out by most hospitals and many health care agencies, government-sponsored local agencies, third-party party payers, and private companies, yet few practical explanations of the process are available. In this guide, the author differentiates between internal and external review and their likely outcomes, outlines the development of a utilization review system, and describes the stages and levels of review. Psychiatric utilization review is especially difficult to carry out; thus it rarely goes beyond evaluating need for hospitalization and length of stay. Utilization review in general still must deal with issues related to confidentiality, the clinical responsibility of the reviewer, and whether certification for admission can reward poor or inappropriate care.

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