Criteria for hospital admission are a necessary element in determining clinically, if not fiscally, whether care needs to be provided in a hospital. The fact of hospital admission emphasizes that a patient is seriously ill and must receive focused and intensive diagnostic and treatment services. Consequently, utilization review that incorporates both admission criteria (determining necessity for hospital care) and concurrent review (determining the appropriateness of the care rendered) becomes a crucial safeguard of quality. Utilization review aimed at ensuring that patients receive the most effective care in the least restrictive setting will meet the mandates of our profession: to provide care when we can and to do no harm. Let us hope that over time high-quality care will emerge as the least costly alternative.