A process to regulate the provision of services in relation to the capacity of the system and needs of consumers. This process should guard against under-utilization as well as over-utilization of services to assure that the frequency and type of services fit the needs of consumers. UM is typically an externally imposed process. UTILIZATION REVIEW (UR) -an analysis of services, through systematic case review, with the goal of reviewing the extent to which necessary care was provided and unnecessary care was avoided. UR is typically an internally imposed process.
Planning, organizing, directing, and controlling the use of medical services by a health care organization.
A process in which decisions about procedures, hospital admissions and other aspects of patient care are managed prospectively and retrospectively for their appropriateness of care and necessity of care. Both overutilization and underutilization are discussed.