MEDICAL PROFESSIONALISM UNDER MANAGED CARE - THE PROS AND CONS OF UTILIZATION REVIEW

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