What is the primary purpose of a utilization review in healthcare management?

The primary purpose of a utilization review in healthcare management is to assess the necessity and appropriateness of services. This process involves evaluating the treatment provided to patients to ensure that it is appropriate for their specific medical conditions and that it aligns with established medical standards and guidelines. By doing so, utilization review helps to optimize patient care by ensuring that patients receive necessary and effective services while also preventing unnecessary treatments that could lead to increased healthcare costs and potential patient harm.

Utilization reviews are essential in maintaining the balance between appropriate care and resource management within healthcare organizations. They are typically carried out by specialized staff who analyze patient records, treatment plans, and clinical outcomes, contributing to quality assurance and improvement within the healthcare setting. This function not only upholds patient safety and care quality but also plays a critical role in managing healthcare expenditures and ensuring that resources are used effectively.