A Systematic Review of Overuse of Care

Alleged overuse of medical services has been said to cause tens of billions of dollars of unnecessary spending every year.  A variety of methods have been suggested to avoid this overuse and the managed care industry came about in part as a way to help ensure appropriate service use.  A review of the research finds that no particular system of care seems to be better than another at tackling this problem.   (Med. Care Article)   The authors found only seven research reports that they deemed useful for a comparison of systems to address overuse.  The articles looked at 3 procedures, one diagnostic test and one medication.  For example, carotid endarterectomy was used inappropriately to the same extent in Medicare FFS and Medicare Advantage.  Overuse of antibiotics for the treatment of upper respiratory infection were higher in a staff model managed care plan than a FFS plan.  Another study did find lower use of certain diagnostic services in a managed care setting versus FFS.  The VA system had rates of inappropriate use similar or even higher than those in private settings.  The reality is that this review is too limit to draw any meaningful conclusions, but it would appear that physicians will order services inappropriately whether they are paid a salary or get a fee-for-service payment and whether they are treating HMO patients or Medicare beneficiaries or any other patients.  There is other evidence finding that certain organized systems may ensure better adherence to best care practice guidelines.  The underlying problem may be that if we want patients’ wishes to be followed, patients often want unnecessary tests and treatments.  And the notion that overuse costs us lots of money is surely overstated and ignores the other side of the coin; that there are many patients who don’t get services that they should get.