Managing Utilization Management: A Purchaser's View Many purchasers rely on utilization management to lower health care costs. Should we be doing more to ensure its safety?

Utilization management (UM) and the reducedvolume ofhealth care services it typically fosters have struck a nerve. Over the past five years, U.S. media, legislators, and opinion polls have expressed increasing concern that reduced service levels may be jeopardizing patients’ well-being. The definition of utilization management varies widely in everyday use as well as in the published literature. The Institute of Medicine (IOM) in a 1989 report adopted a narrow focus oncase-by-case preservice reviewsponsored by purchasers. 1