Health Costs High From Overuse of Services

JAMA

Archives of Internal Medicines

There’s a problem with health care in the United States that has been understudied, despite the fact that it’s a contributor to high costs. According to a study in ’s , the overuse of health care services can be attributed to as much as 30% of U.S. health care spending.

According to the authors, there are three quality problem categories in health care: underuse, the lack of provision for necessary care; misuse, wrong care is provided; and overuse, where medical services are provided that have no benefit or for which harms outweigh benefits.

While there has been research provided on underuse of health care services, “overuse research has been underemphasized…” The authors go on to suggest that “because it is difficult to define, study, and document, overuse has not become a standard component of quality of care assessments.”

In fact, the authors had trouble finding data, only unearthing 172 articles on overuse.

“Despite interest in reducing inappropriate care in the United States, the overuse literature includes relatively few procedures and diagnostic tests, and particularly few newer costly ones,” wrote authors Deborah Korenstein, MD; Raphael Falk, MD, MPH; Elizabeth A. Howell, MD, MPP; Tara Bishop, MD, MPH; and Salomeh Keyhani, MD, MPH.

The authors did find that some overuse has decline over the years, including rates for inappropriate carotid endarterectomy to remove carotid artery plaque. Where they found overuse was the most prevalent was in preventive services, which could substantial costs.

JAMA

In a comment published by , Mitchell H. Katz, MD, noted how little research is available on the topic of overuse.

“What is most striking about this report is how hard the authors searched for data on overuse of health care and how little they found,” he wrote. “If we are to improve health care in the United States, we must know as much about overuse of health care as we do about underuse of health care.”