Overuse of medical services has been a pervasive problem within the United States, in large part owing to the fee-for-service payment model. Amid expansion of commercial health insurance in the 1960s, utilization review arose as a method for payers to assess the appropriateness of recommended services, thereby controlling costs.1 Although utilization review has the potential to benefit all stakeholders by ensuring that patients receive appropriate care, controlling health care spending, and aligning clinicians with evidence-based care, there is also potential for harm. Critics contend that utilization management tools, such as prior authorization, can hinder access to treatments without lower-cost alternatives. The American Society for Radiation Oncology (ASTRO) has made utilization management reform a central platform of its advocacy efforts, arguing that prior authorization results in increased patient anxiety, administrative burden, and unnecessary delays.2 Despite this debate, investigation into the association of utilization management with radiation oncology services remains limited.
Identify all potential conflicts of interest that might be relevant to your comment.
Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
Err on the side of full disclosure.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.
Not all submitted comments are published. Please see our commenting policy for details.
Chang EM, Falit BP, Raldow AC. Evaluating a Utilization Management Policy in Radiation Oncology. JAMA Oncol. 2020;6(6):846–847. doi:10.1001/jamaoncol.2020.0447
Coronavirus Resource Center
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: