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Overtreatment in the United States

Author

Listed:
  • Heather Lyu
  • Tim Xu
  • Daniel Brotman
  • Brandan Mayer-Blackwell
  • Michol Cooper
  • Michael Daniel
  • Elizabeth C Wick
  • Vikas Saini
  • Shannon Brownlee
  • Martin A Makary

Abstract

Background: Overtreatment is a cause of preventable harm and waste in health care. Little is known about clinician perspectives on the problem. In this study, physicians were surveyed on the prevalence, causes, and implications of overtreatment. Methods: 2,106 physicians from an online community composed of doctors from the American Medical Association (AMA) masterfile participated in a survey. The survey inquired about the extent of overutilization, as well as causes, solutions, and implications for health care. Main outcome measures included: percentage of unnecessary medical care, most commonly cited reasons of overtreatment, potential solutions, and responses regarding association of profit and overtreatment. Findings: The response rate was 70.1%. Physicians reported that an interpolated median of 20.6% of overall medical care was unnecessary, including 22.0% of prescription medications, 24.9% of tests, and 11.1% of procedures. The most common cited reasons for overtreatment were fear of malpractice (84.7%), patient pressure/request (59.0%), and difficulty accessing medical records (38.2%). Potential solutions identified were training residents on appropriateness criteria (55.2%), easy access to outside health records (52.0%), and more practice guidelines (51.5%). Most respondents (70.8%) believed that physicians are more likely to perform unnecessary procedures when they profit from them. Most respondents believed that de-emphasizing fee-for-service physician compensation would reduce health care utilization and costs. Conclusion: From the physician perspective, overtreatment is common. Efforts to address the problem should consider the causes and solutions offered by physicians.

Suggested Citation

  • Heather Lyu & Tim Xu & Daniel Brotman & Brandan Mayer-Blackwell & Michol Cooper & Michael Daniel & Elizabeth C Wick & Vikas Saini & Shannon Brownlee & Martin A Makary, 2017. "Overtreatment in the United States," PLOS ONE, Public Library of Science, vol. 12(9), pages 1-11, September.
  • Handle: RePEc:plo:pone00:0181970
    DOI: 10.1371/journal.pone.0181970
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    Cited by:

    1. Balafoutas, Loukas & Fornwagner, Helena & Kerschbamer, Rudolf & Sutter, Matthias & Tverdostup, Maryna, 2020. "Diagnostic Uncertainty and Insurance Coverage in Credence Goods Markets," IZA Discussion Papers 13848, Institute of Labor Economics (IZA).
    2. Durr-e-Nayab & Shujaat Farooq & Nabila Kunwal, 2024. "Utilisation Challenges of Public Health Insurance Initiatives: Evidences from Sehat Sahulat Programme (SSP) in Pakistan (Policy)," The Pakistan Development Review, Pakistan Institute of Development Economics, vol. 63(2), pages 247-288.
    3. Hensher, Martin & Canny, Ben & Zimitat, Craig & Campbell, Julie & Palmer, Andrew, 2020. "Health care, overconsumption and uneconomic growth: A conceptual framework," Social Science & Medicine, Elsevier, vol. 266(C).
    4. Zhang, Xuan, 2022. "The effects of physician retirement on patient outcomes: Anticipation and disruption," Journal of Public Economics, Elsevier, vol. 207(C).
    5. Loukas Balafoutas & Helena Fornwagner & Rudolf Kerschbamer & Matthias Sutter & Maryna Tverdostup, 2023. "Serving Consumers in an Uncertain World: A Credence Goods Experiment," ECONtribute Discussion Papers Series 258, University of Bonn and University of Cologne, Germany.
    6. Damon Centola & Douglas Guilbeault & Urmimala Sarkar & Elaine Khoong & Jingwen Zhang, 2021. "The reduction of race and gender bias in clinical treatment recommendations using clinician peer networks in an experimental setting," Nature Communications, Nature, vol. 12(1), pages 1-10, December.
    7. Maximilian Pausch & Angela Schedlbauer & Maren Weiss & Thomas Kuehlein & Susann Hueber, 2020. "Is it really always only the others who are to blame? GP’s view on medical overuse. A questionnaire study," PLOS ONE, Public Library of Science, vol. 15(1), pages 1-15, January.
    8. Diwas Singh KC, 2020. "Heuristic Thinking in Patient Care," Management Science, INFORMS, vol. 66(6), pages 2545-2563, June.
    9. Freedman, Seth & Golberstein, Ezra & Huang, Tsan-Yao & Satin, David J. & Smith, Laura Barrie, 2021. "Docs with their eyes on the clock? The effect of time pressures on primary care productivity," Journal of Health Economics, Elsevier, vol. 77(C).

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