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Prior Authorization as a Potential Support of Patient-Centered Care

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Abstract

We discuss the role of prior authorization (PA) in supporting patient-centered care (PCC) by directing health system resources and thus the ability to better meet the needs of individual patients. We begin with an account of PCC as a standard that should be aimed for in patient care. In order to achieve widespread PCC, appropriate resource management is essential in a healthcare system. This brings us to PA, and we present an idealized view of PA in order to argue how at its best, it can contribute to the provision of PCC. PA is a means of cost saving and as such it has mixed success. The example of the US demonstrates how implementation of PA has increased health inequalities whereas best practice has the potential to reduce them. In contrast, systems of universal coverage, like those in Europe, may use the cost savings of PA to better address individuals’ care and PCC. The conclusion we offer therefore is an optimistic one, pointing towards areas of supportive overlap between PCC and PA where usually the incongruities are most evident.

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Author information

Authors and Affiliations

  1. University of Oxford, the Ethox Centre, Nuffield Department of Population Health, Oxford, UK

    Leah Rand

  2. Johns Hopkins Outpatient Center, 601 N Caroline St Suite 7143, Baltimore, MD, 21287, USA

    Zackary Berger

  3. Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA

    Zackary Berger

Authors
  1. Leah Rand
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  2. Zackary Berger
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Contributions

LR developed the argument and wrote the initial draft. ZB helped refine the argument and draft and assisted in response to the reviewers.

Corresponding author

Correspondence to Zackary Berger.

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Funding

This study was unfunded.

Conflict of interest

ZB publishes frequently on patient-centered care and shared decision making, and sees Medicaid-insured patients affected by prior authorizations as part of his clinical practice. LR declares no conflicts of interest.

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Rand, L., Berger, Z. Prior Authorization as a Potential Support of Patient-Centered Care. Patient 11, 371–375 (2018). https://doi.org/10.1007/s40271-018-0299-3

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