APPROPRIATENESS VERSUS EFFICIENCY - THE ECONOMICS OF UTILIZATION REVIEW

The aim of routine utilisation review is to identify patients who are inappropriately place in an acute unit and who could be alternatively treated in a lower technology facility. Utilisation review was designe d as a means of cost control in the USA, but problems with rising emer gency admissions and consequent acute bed shortages in the UK have led to a substantial and growing interest in the concept of appropriatene ss and in the development of utilisation review instruments. Appropria te care is not necessarily the same as efficient care, however, and in appropriate care could potentially be more cost-effective than the alt ernative. This will depend on, first, whether the design of utilisatio n review instruments is such that they will encourage efficiency, and second, whether efficiency objectives would be met by the application of utilisation review in the context of the UK health care system. The first issue is discussed in relation to the effectiveness of alternat ive forms of care. The second is discussed in relation to the potentia l for reductions in cost, the issue of institutional resistance in the UK, and the validity of utilisation review instruments. The paper con cludes that the potential impact of utilisation review on technical ef ficiency in the UK is ambiguous and questions its purpose in the Natio nal Health Service.