What does "utilization review" evaluate?

Utilization review is a systematic process used to evaluate the necessity and efficiency of healthcare services provided to patients. This process involves assessing whether the healthcare services given are appropriate for the specific patient's condition, whether they meet the established treatment criteria, and if they are delivered in a cost-effective manner. By focusing on the necessity of services, utilization review helps ensure that patients receive the right care at the right time while also managing healthcare costs.

The review process is usually conducted by trained professionals who analyze clinical data, treatment plans, and the appropriateness of care based on established guidelines. This not only helps in determining the necessity of services but also assesses whether they are delivered efficiently, preventing unnecessary procedures and promoting the wise use of healthcare resources.

In this context, the other options do not accurately represent the scope of utilization review. Financial performance pertains to the organization’s overall financial health rather than individual patient care evaluations. Quality of patient interactions focuses on the subjective experiences of patients rather than the efficiency and necessity of services rendered. Geographic distribution deals with how healthcare services are spread across different locations, while utilization review specifically aims to analyze care appropriateness and efficiency without geographical considerations.