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Hospital Utilization Reviews

Everett McClenahan, MD
JAMA. 1966;196(11):999-1004. doi:10.1001/jama.1966.03100240133031.
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Pre-Medicare utilization may be compared and contrasted with post-Medicare utilization:

The basic concept of pre-Medicare utilization is physician education, while post-Medicare utilization reviews have as their basis an act of Congress making these reviews mandatory by those rendering service. One applies to care rendered to persons of all ages, the other only to care given those over 65 years of age. One is based, more or less, on an honorary system, the other on a law. It is most unfortunate that the same title has been applied to both, for it is possible that one can destroy the beneficial effects of the other. It is hoped that post-Medicare utilization reviews will be able to incorporate the benefits of pre-Medicare utilization measures.

There is little doubt that it is basically correct that decisions relative to admissions, stay rates, and discharge policies are unavoidable, when one recognizes that third parties are paying


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