Unnecessary medical treatment costs US up to $800bn per year
3 October 2012
Leading doctors are calling for action to tackle unnecessary
care that is estimated to account for up to $800bn in the United States
In a special report for the BMJ, journalist Jeanne Lenzer
describes how a new movement led by prominent doctors is challenging
the basic assumption in US healthcare that more is better.
The report comes as an international conference ‘Preventing
Overdiagnosis’ is announced for September 2013 in the United States,
hosted by The Dartmouth Institute for Health Policy and Clinical
Practice, in partnership with the BMJ, the leading consumer
organisation Consumer Reports and Bond University, Australia .
In the US, overly aggressive treatment is estimated to cause
30,000 deaths among Medicare recipients alone each year, while
unnecessary interventions are estimated to account for 10-30% of
spending on healthcare, or $250bn-$800bn (£154bn-£490bn) annually.
Examples range from the overuse of screening tests and imaging
technology to an epidemic of questionable surgery. Such statistics
led a group of prominent doctors from the US, Canada and the UK to
come together and discuss how to avoid the harm caused to patients
Many of them have been warning for decades about the harms of
overtreatment, but it is only now, with global financial downturns
and growing awareness of the unsustainability of healthcare
spending, that the issue is receiving significant attention from the
American media and politicians.
They identified several reasons for overtreatment, including
malpractice fears, biased research, patient demand, and financial
conflicts of guideline writers. Other commonly cited problems
included the rapid uptake of unproved technology and the failure to
inform patients fully of the potential harms of elective treatments.
Several speakers highlighted the way physicians are paid and trained
in the US as central factors, and nearly 80% believed that more
radical payment reform is necessary to reduce the problem
But as these initiatives begin to move forward, they will face
formidable challenges from the healthcare industry and the general
public who argue that the overtreatment movement is simply a scheme
to ration care, reports Lenzer.
Supporters of reducing overtreatment vigorously oppose this view.
“Rationing means that you are limiting necessary care. What we are
proposing is limiting unnecessary care – harmful care,” argues Dr
Diane Meier, Professor of Geriatrics and Internal Medicine at Mount
Sinai School of Medicine.
Jerome R Hoffman, Emeritus Professor of Medicine at the
University of California, Los Angeles, adds: “There’s already lots
of rationing in healthcare; wouldn’t it be better for us to decide
what should be available, based on what’s best for our health,
rather than having insurance companies decide, based on what’s most
profitable for them?”
They also point out that resources wasted on unnecessary care can
be much better spent treating and preventing genuine illness in
those who are underinsured or uninsured.
Ultimately, engaging clinicians at an international level will be
key to moving these issues forward. Dr Shannon Brownlee, author of
Overtreated: How Too Much Medicine is Making Us Sicker and Poorer
says: “The crucial step right now is to get the medical community
mobilized around the idea that overtreatment harms patients.”
The conference website:
2. The BMJ article is available at: