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June 13, 1966

Medicare and Utilization Review

Author Affiliations

Director, Bureau of Health Insurance, Social Security Administration.

JAMA. 1966;196(11):995-998. doi:10.1001/jama.1966.03100240129029

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The emerging concept of utilization review has one compelling justification—it is the way in which doctors, working together and accountable to each other, can assure that each patient in medical need will have fair access to and an optimum use of scarce and expensive facilities. In implementing the new law the Social Security Administration will do everything possible to accommodate and encourage existing practices—however variable they may be—so long as they give promise, under professional direction, of assuring quality care to patients through sound utilization of hospital facilities and services.

I find there is full agreement that professional people must be responsible for determining how such reviews can best be done, but that some concern exists over the question of how the program will ascertain, once the institution establishes a utilization review plan, that the plan is in existence and operates effectively.

Conditions for Participation for Hospitals and Extended-Care Facilities 

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