Evaluating a Utilization Management Policy in Radiation Oncology
Menée aux Etats-Unis à partir de données 2012-2018 portant sur 1 540 patientes atteintes d’un cancer du sein de stade précoce, cette étude rétrospective analyse l’association entre la politique de gestion de l’utilisation des soins, le recours effectif des patientes à la radiothérapie hypofractionnée et les coûts associés
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.
JAMA Oncology , commentaire, 2019