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Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
The Andersen healthcare utilization model is a conceptual model aimed at demonstrating the factors that lead to the use of health services. According to the model, the usage of health services (including inpatient care, physician visits, dental care etc.) is determined by three dynamics: predisposing factors, enabling factors, and need.
Drug utilization review acted as a background paper written by the United States Department of Health, Education, and Welfare task force. This task force considered that drug utilization review was potential but this review should be evaluated and need valid evidence to put into effect. [7]
In 2006, mental disorders were ranked one of the top five most costly medical conditions, with expenditures of $57.5 billion (equivalent to $83.6 billion in 2023 [108]). [246] A lack of mental health coverage for Americans bears significant ramifications to the US economy and social system.
The primary objective of the Canadian healthcare policy, as set out in the 1984 Canada Health Act (CHA), is to "protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers."
The health effects of wildfire smoke, such as worsening cardiovascular and respiratory conditions, extend beyond immediate exposure, contributing to nearly 16,000 annual deaths, a number expected to rise to 30,000 by 2050. The economic impact is also significant, with projected costs reaching $240 billion annually by 2050, surpassing other ...