More Than 20% of All Medical Care Unnecessary

A recent physician-focused survey in PLOS One found that physicians believe more than 20% of all medical care is unnecessary.

“In 2010, the Institute of Medicine (IOM) called attention to the problem, suggesting that “unnecessary services” are the largest contributor to waste in United States health care, accounting for approximately $210 billion of the estimated $750 billion in excess spending each year,” Heather Lyu, MD, of the department of surgery at Brigham and Women’s Hospital at Harvard Medical School, and colleagues wrote. “o draw on this knowledge, we designed a study to estimate physicians’ perspective on the prevalence of overtreatment in health care and identify potential causes and solutions.”

The researchers surveyed 2106 physicians using an online community of providers accredited by the AMA. The survey queried participants on the prevalence of overutilization, what causes overutilization, solutions for curbing overutilization, and the overall impact of overutilization on the health care system.

Study results showed that participants felt that 20.6% of all medical care was overutilization. Furthermore, they responded that 22% of prescription medication use was unnecessary, 24.9% of tests were unnecessary, and 11.1% of procedures were performed without a necessary clinical reason.
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Dr Lyu and colleagues found that the most common reason given for participation in overutilization was “fear of malpractice.” Other causes included pressure from patients and difficulty assessing medical records.

Physicians responded that moving away from fee-for-service payments would curb overtreatment. The researchers noted that 70.8% of physicians believed that overutilization is more prevalent when physicians are paid for it. They concluded that more education regarding wasteful care is necessary.

“Health care utilization by physicians may be influenced by the cost environment in which they trained as residents, suggesting that early intervention may be helpful,” the researchers wrote. “Training on appropriateness criteria and practice guidelines should be a priority for the future.” —David Costill