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Medical Professionalism under Managed Care: The Pros and Cons of Utilization Review

Citation

Schlesinger, Mark J.; Gray, Bradford H.; & Perreira, Krista M. (1997). Medical Professionalism under Managed Care: The Pros and Cons of Utilization Review. Health Affairs, 16(1), 106-24.

Abstract

We contend that the full consequences of managed care for American medicine and health care professionals can be more fully understood if strategies for managing care are identified-in particular, strategies for the administrative oversight of professional decision making. In this paper we apply this perspective to the study of third-party utilization review, making use of a national survey of firms contracting to provide prior authorization for hospitalization in 1992. Survey data suggest that (1) existing approaches to utilization review differ greatly among review firms; (2) review practices that might improve agency and accountability seem to be overlooked by most review firms; and (3) a large number of review firms employ practices that undermine professional autonomy in seemingly inappropriate ways.

URL

http://dx.doi.org/10.1377/hlthaff.16.1.106

Reference Type

Journal Article

Journal Title

Health Affairs

Author(s)

Schlesinger, Mark J.
Gray, Bradford H.
Perreira, Krista M.

Year Published

1997

Volume Number

16

Issue Number

1

Pages

106-24

Reference ID

4331