Which process is essential for ensuring that healthcare services are necessary?

Utilization Review is a critical process in healthcare that ensures the services provided to patients are necessary and appropriate based on established guidelines and criteria. This process typically involves assessing the medical necessity of interventions, length of stay, and the appropriateness of the course of treatment. By evaluating whether the healthcare services align with the patient's needs and ensuring they are required for their condition, utilization review plays a key role in reducing unnecessary procedures, controlling costs, and enhancing the quality of patient care.

As healthcare systems strive to maintain balance between patient care and cost management, utilization review serves as a safeguard to prevent overutilization or underutilization of services, thereby helping manage the overall efficiency of the healthcare delivery system. This not only aids in ensuring patients receive suitable care but also assists in the financial management of healthcare organizations by promoting better resource allocation. The focus on the necessity of services distinguishes utilization review from processes such as cost analysis or cash flow management, which are more centered on financial metrics rather than the appropriateness of care itself.