By NextBestFitLow-value care and overtreatment
Tests and treatments with little benefit (imaging for routine back pain, some screenings, end-of-life interventions patients don't want) cost an estimated $76–101B a year.
Evidence
- Overtreatment or low-value care $76–101B a year.
Who's affected
- People with ongoing or specialist care needs: Low-benefit tests and treatments expose them to harm.
- Health insurers, brokers, and their shareholders: They pay for tests and treatments with little benefit.
- Taxpayers and public budgets: They pay for tests and treatments with little benefit.
- Hospitals, clinics, and care organizations: Per-service payments reward additional low-value care.
- Drug and device makers: They sell devices and tests used in low-value care.
Under your mix of paths
- Fee-for-service
- Defensive medicine
- Patient demand without evidence
Related costs
Open questions
- Who decides what is low-value, and should it be excluded from coverage or just discouraged?
Caused or worsened by these paths
This problem only matters if one of these paths is chosen.
Removing most advance review risks more low-value care.
Payment per service continues to encourage greater service volume even with fixed national rates.
Free screening can increase use of screening that is low-value.
Extra payment beyond baseline volume creates an incentive to perform more procedures.
Letting hospitals invest capital components of payments can fund duplicate equipment or facilities.
Solution paths (2)
Open a path for what it fixes, what it creates or worsens, who gains and who loses, precedents, and how it connects to other paths. See all paths as a decision tree.
A public body reviews evidence and stops covering services proven not to work.
- +Low-value care and overtreatment
- +Medical errors and poor care coordination
- −Depends on uncertain evidence or judgments
- −Central coverage decisions can feel like rationing
Report low-value care rates to clinicians and use EHR alerts.
- +Low-value care and overtreatment
- −Solves only part of the problem
- −Clinician burnout from paperwork and EHR work
Also addressed by paths for other problems
Small patient charges discourage low-value use.
Charging only for low-value services discourages waste while needed care remains free.
An annual operating budget removes the incentive to provide extra services to earn more revenue.
Compensating injured patients without lawsuits reduces defensive medicine.
A national record that follows patients reduces duplicate tests.
Allocating major equipment through a separate regional capital budget prevents duplicate equipment arms races.
Assessment before coverage avoids paying for unproven drugs.
Small flat charges for selected services, such as non-emergency emergency-room use, target specific overuse.