Utilization Review And Quality Management Essay

1077 Words Jan 18th, 2016 null Page
By the year, 2024 United States Government and local governments will have spent at least half of its national budget on healthcare according to a recent study issued by the federal government (Luhby, 2015, para. 9), which is in part due to the Affordable Care Act. In addition, the government has estimated by 2024 that the cost of healthcare for each person will rise at least 5.8% per year (Luhby, 2015, para. 4), which in some way is due to the rising age of the American population. Therefore, utilization review and quality management become more critical as the cost of healthcare continues to rise. Utilization review and quality management go hand in hand, but they are distinctly different in managing the costs of healthcare. Utilization review utilizes prospective, current, and retrospective features to help curtail the rising cost of healthcare, improve services for patients, and improve the quality of healthcare services (Kongstvedt, 2016, p. 162) for the medical provider and insurance. On the other hand, quality management encompasses philosophical, structural, and healthcare specific components that make up what we know as quality care in the United States (Sollecito & Johnson, 2013) for the patient.
Utilization management relies heavily on the prospective evaluations, so that healthcare services will not be over utilized, thus saving the insurance and patient money. One aspect of perspective utilization involves demand management, which empowers the patient to not…

Related Documents