Chapter 10: Managing the Use of Healthcare Resources

1. What UM practices does your health insurance company follow to control costs and ensure provision of medically necessary services? This information may be available in your insurance benefits booklet or on your health plan's website. If you do not have health insurance, go to the website of any major health insurance company and list the practices this company follows to control costs and to ensure the provision of medically necessary services.
2. A hospital's UM committee discovers that the rate of cesarean section births at the hospital is higher than the rate at other hospitals in the region. A higher percentage of women at other hospitals are having vaginal deliveries. The UM committee wants to evaluate the medical necessity of cesarean section births at the hospital using clinical practice guidelines on this topic. Go to the website of the National Guideline Clearinghouse (www.guideline.gov) to find the most current recommendations that address the indications for a cesarean section birth; and write a summary of the indications for the committee to consider.