Utilization management in the clinical laboratory: An introduction and overview

Abstract

Expenditures for heath care in developed economies have been rising steadily over the past decades and have become unsustainable in many countries. This is particularly true in the United States (US) where the country spends more on health care as a percent of gross domestic product that any other country. Changes to the US system of reimbursement for medical services are gradually eroding the traditional fee-for-service model in favor of global payments for episodes of care or even entire populations of patients. In this environment utilization management is gaining an increasingly important role in efforts to control cost and improve the quality of care. This chapter introduces many of the key topics in utilization management and provides a “toolbox” of strategies to support implementation of utilization management initiatives. Many examples of successful initiatives in the literature and in our institution will be described. Further details are provided in the accompanying chapters of this book.