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A few applications of the utilitarian bioethics in policy are the Groningen Protocol in the Netherlands and the Advance Directives Act in Texas. In the 1990s, backlash against utilitarian bioethics emerged, led by such figures as Wesley J. Smith and novelist Dean Koontz. [3] [4] Philosopher Bernard Williams was also critical of the utilitarian ...
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.
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 rationale for these new policies ranges from respect for consumer or patient rights to more utilitarian arguments such as that shared decision-making could help control health care costs. [71] However, in general the gap between political aspirations and practical reality is still yawning.
Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers to manage the cost of health care benefits by assessing its appropriateness before it is provided using evidence-based criteria or guidelines.
Unwarranted variations in medical practice refer to the differences in care that cannot be explained by the illness/medical need or by patient preferences. The term “unwarranted variations” was first coined by Dr. John Wennberg when he observed small area (geographic) and practice style variations, which were not based on clinical rationale. [5]