What is the term that refers to evaluating the appropriateness of a healthcare service's setting and level of service?

Utilization review is a systematic process that assesses the necessity, appropriateness, and effectiveness of healthcare services, including the setting in which the services are provided. This evaluation helps ensure that patients receive care that is not only medically necessary but also delivered in the most suitable environment, whether that be inpatient, outpatient, or another healthcare setting.

This practice plays a vital role in controlling healthcare costs while maintaining quality of care and avoiding unnecessary services. It involves analysis of treatment options and healthcare outcomes to optimize resource use, ensuring that patients receive the right care at the right time, and in the right place.

Quality assurance, while related to maintaining standards and ensuring quality in healthcare delivery, focuses more broadly on the overarching policies and practices that affect patient care rather than specific evaluations of individual services in their context. Clinical guidelines provide evidence-based recommendations for treating various conditions but do not inherently evaluate the appropriateness of the service setting itself. Health management involves broader concepts of overseeing and coordinating health services, but again, doesn't narrow down to the setting's appropriateness for specific services. Therefore, utilization review is the most precise term for evaluating the appropriateness of a healthcare service's setting and level of service.