Utilization Review is primarily used as a cost-control measure by managed care organizations to ensure what?

• A. To speed up patient discharge.
• B. To reduce staff overtime.
• C. To maximize hospital profits.
• D. To ensure medical necessity and appropriate use of resources.

Answer: (D)

Utilization review focuses on whether the care a patient receives is medically necessary and whether resources are being used appropriately. In managed care, this means evaluating procedures, tests, hospital stays, and the setting of care against established guidelines to approve, modify, or deny services. The aim is to control costs while preserving quality by preventing unnecessary or inappropriate use of care. It’s not about speeding discharge, reducing overtime, or maximizing profits—the central idea is ensuring medical necessity and proper use of resources.