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Utilization Review

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  • Topic: Utilization review
  • Topic: Financial barriers to care
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Utilization Management Can Negatively Impact Health Care Quality and Access

June 1, 1999 | Program Result

From 1992 to 1997, researchers at the University of Washington School of Public Health and Community Medicine evaluated the effects of utilization management on health care quality and access.

Reducing Payment for Imaging in Referring Doctor's Facility Does Not Reduce Utilization

August 1, 1998 | Program Result

From 1994 to 1996, researcher teams at the University of Virginia and the Primary Care Outcomes Research Institute (PCORI) at the New England Medical Center conducted two distinct but parallel studies.

Analytical Models Project the Utilization and Costs of Long-Term Care

July 1, 1998 | Program Result

The Long-Term Care Data Institute reviewed analytical models then in use for projecting the utilization and costs of different long-term care scenarios, and then used the information gleaned from its analysis to rework its own model.

Physicians Among the Chief Drivers of High Drug Costs

January 1, 2001 | Program Result

During the 1980s, expenditures on pharmaceuticals nationwide increased by 152 percent. HMOs implemented a number of cost-control mechanisms to slow the rate of growth of pharmaceutical expenditures, and were successful in doing so compared to fee-for-service health plans.

Making Health Insurance More Affordable for Small Businesses

January 1, 2001 | Program Result

Starting in September 1991, researchers at the Pittsburgh Research Institute, Pittsburgh, compared the health care costs and use for employees at small firms and individual health plan subscribers with employees at large firms.

Variations Found During Physician Profiling Study Are Difficult to Explain

March 1, 2000 | Program Result

The Center for Research in Ambulatory Health Care Administration developed, tested and demonstrated a national physician profiling system for ambulatory health care.

How Managed Care Can Set Limits on Medical Technology - and Look Good

September 1, 2000 | Program Result

From 1996 to 1998, Harvard Pilgrim Health Care examined how insurers, employers and other purchasers of health care decide which medical technologies to provide to consumers under resource constraints.

How Do Doctors Decide What Care is Necessary for Mental Health Problems?

November 1, 1996 | Program Result

Harvard Pilgrim Health Care documented the implicit criteria used to determine "medical necessity" related to mental health, and the influences of financial incentives and organizational arrangements on medical necessity decisions.

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