What is the purpose of a utilization review in a hospital setting?

Utilization review plays a critical role in overseeing and evaluating the necessity and efficiency of patient care in hospital settings. Specifically, its primary purpose is to control patient treatment costs by ensuring that the services provided are appropriate and necessary for the patient's medical condition. This process involves reviewing patient treatment plans, procedures, and hospital stays to determine their medical necessity and to prevent potential overutilization of resources.

By focusing on cost control, utilization review helps to align patient care with both clinical guidelines and economic considerations, making it an essential component of quality assurance in healthcare. This approach not only helps manage expenses but also ensures that patient care is both effective and aligned with established standards.