Unnecessary healthcare, also termed overutilization, overuse, or overtreatment, refers to medical interventions provided with higher volume or cost than is clinically necessary or appropriate for patients.
Unnecessary healthcare in the U.S. is driven by systemic, financial, and cultural factors, resulting in high costs and increased patient risk without substantial health benefits.
Prevalence and Impact Unnecessary healthcare is highly prevalent in the United States, accounting for an estimated one-third of total healthcare spending.
10 to 34% of all medical care is considered to be low-value, and 20 to 50% of medical imaging may be unnecessary.
Between $0.30 and $0.40 of every healthcare dollar is spent on poor quality care, and more than half a trillion dollars is wasted annually due to overuse, underuse, misuse, duplication, system failures, unnecessary repetition, and inefficiency.
Causes and Incentives
Drivers of unnecessary healthcare include: Fee-for-service payment models that incentivize higher volumes of procedures. Defensive medicine practices aimed at avoiding litigation. Patients encouraged by direct-to-consumer advertising to request medications, devices, diagnostics, or procedures. Lack of price sensitivity, as insurance pays for services rather than patients directly.
Physician predispositions, such as quickly acting instead of monitoring, preferring newer treatments without comparing effectiveness, or treating terminal illness to maximize lifespan without considering patient preferences.
There is no apparent health benefit for Medicare recipients in higher-spending regions; increased healthcare spending does not result in improved outcomes or satisfaction.
Overuse puts patients at risk of complications and harm, especially from surgeries, excessive imaging, and other treatments.
Up to 30% of Medicare spending could be cut without harming patients.
Examples:
Excessive diagnostic imaging. Overtreatment for self-limited or minor conditions and overdiagnosis.
Hospitalizations for chronic conditions that could be managed as outpatient cases.
Surgeries in patients during their last year of life, antibiotic use for viral infections, excessive opioid prescriptions, and unnecessary screenings for cancers in advanced cancer patients.
Overmedicalization in pediatrics, such as unnecessary planned early deliveries, use of commercial rehydration solutions, and overdiagnosis of hypoxemia.
Parsimonious care is defined as using the most efficient means to diagnose and treat patients, focusing on quality over quantity and science-based practices to avoid unnecessary interventions.