EFFECT OF HOSPITAL UTILIZATION REVIEW ON MEDICAL EXPENDITURES IN SELECTED DIAGNOSTIC AREAS - AN EXPLORATORY-STUDY

Quarterly claims data on 43 insured groups were analyzed through multivariate techniques to explore whether the effects of hospital inpatient utilization review vary across selected broad diagnostic areas. Findings suggest that utilization review was associated with decreases in expenditures of approximately 15 percent for diagnoses within the surgical area, a lesser decrease within the mental health area, and still lesser decrease within the medical area. However, these measurements are imprecise both because of the small numbers and the aggregated diagnoses in each category.