Overtreatment in the U.S. has negative impacts on patient well-being and increases the overall cost of healthcare. As one of the largest developed nations in the world, the U.S. spends more than any other country on healthcare [1]. However, hundreds of billions of dollars are wasted every year on unnecessary services [2]. These unnecessary services, which can include screenings, surgeries, and prescriptions, can also be harmful to patients. Examples of tangible harm to patient health include antibiotic resistance from over-prescription and postoperative complications that can result from an unnecessary procedure [2]. This exponential increase in overtreatment is often attributed to a healthcare model that is not centered around the patient.

The compromises made to ensure the passage of the Medicare Act of 1965 allowed for the rise of the modern-day medical industry. Hospitals and medical manufacturing have proliferated in the decades since its passage, while providers are increasingly pushed to focus on profit [3]. U.S. healthcare has become focused on the hospital as the center of care, with increased technologization and specialization driving industry growth [4]. Whereas primary care forms the bulk of services in other high-income nations, the U.S. healthcare system is driven by rescue-based care in a hospital setting. This is partly because doctors are typically reimbursed by the volume of services rendered, which raises costs significantly [4]. As a result, medical professionals are de-incentivized from providing routine preventative care and encouraged to provide additional services that may not be necessary for positive outcomes. Indeed, despite having the highest cost of healthcare in the world, the U.S. has one of the lowest average life expectancies among high-income nations [5].        

A significant reduction in overtreatment will require changes to the existing system. Mitigating efforts can start with small shifts that create a more holistic approach to treatment. A panel of medical experts convened to address the issue proposed several possibilities, including encouraging primary care doctors to offer more detailed descriptions of patients’ lifestyles and values in their medical records so that those factors could be taken into consideration wherever the patient receives treatment [6]. Another proposal was as simple as making sure enough chairs are present in the ER or ICU so that doctors could sit with patients and their families to discuss treatment priorities [6].

COVID-19 has been an unforeseen catalyst in rethinking the tendency toward overtreatment. Because healthcare providers were overwhelmed by the pandemic, many non-urgent procedures were canceled or postponed. In other cases, patients voluntarily forewent treatment to avoid being exposed to the virus. The result is that doctors now have a large control group of patients who did not receive commonly prescribed but unnecessary treatments, which can be compared against those who did receive those treatments [7]. Even after the pandemic has subsided, this change in mindset may lead to a reduction in overtreatment.  

References

[1] Shrank WH, Rogstad TL, Parekh N. “Waste in the US Health Care System: Estimated Costs and Potential for Savings.” JAMA, vol. 322, no. 15, 2019, pp.1501-1509, doi: 10.1001/jama.2019.13978. PMID: 31589283.

[2] Lyu, Heather, et al. “Overtreatment in the United States.” PLoS ONE, vol. 12, no. 9, 2017, doi: 10.1371/journal.pone.0181970.

[3] Berwick, Donald and Andrew Hackbarth. “Eliminating Waste in US Health Care.” JAMA, vol. 307, no. 14, 2012, pp.1513–1516, doi: 10.1001/jama.2012.362.

[4] Shannon Brownlee | Lown Institute Senior Vice President | “Overtreatment is One of Healthcare’s Greatest Challanges.” Health Rosetta, 2020, https://healthrosetta.org/education/ shannon-brownlee-overtreatment/

[5] Roosa Tikkanen | “US Healthcare from a Global Perspective, 2019: Higher Spending, Worse Outcomes?” The Commonwealth Fund, 2020, https://www.commonwealthfund.org/publications/ issue-briefs/2020/jan/us-health-care-global-perspective-2019.

[6] Paige Minemyer | “A Simple Potential Solution to Overtreatment in Healthcare? Try Adding Chairs” Fierce Healthcare, 2018, https://www.fiercehealthcare.com/hospitals-health-systems/ a-simple-potential-solution-to-overtreatment-more-chairs.

[7] Bruce Alpert | “Pandemic Leads Doctors to Rethink Unnecessary Treatment.” Kaiser Health News, 2021, https://khn.org/news/article/pandemic-leads-doctors-to-rethink-unnecessary-treatment/