The effect of utilization review on hospital use and expenditures: a review of the literature and an update on recent findings.

Thomas M. Wickizer, Ph.D. is Assistant Professor in the Department of Health Services at the University of Washington, Seattle. The nature of the traditional relationships among providers, payers, and patients in the United States is changing as a result of cost containment pressures. Not long ago, privately insured patients could seek medical care under the guidance of their physician and remain largely unconcerned about the cost implications of the care they received. Decisions about the type of medical care provided and the treatment setting were made by patient and physician with few, if any, external constraints.