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Volume Over Value: A Major Problem in Healthcare

Overuse in healthcare refers to the excessive or unnecessary use of medical services, treatments, tests or interventions that may not provide additional benefits to patients—and may even cause harm. This is an issue with severe consequences, including increased healthcare costs, potential side effects or complications from unnecessary procedures and the diversion of resources from patients who genuinely need care. 


According to 2014 Health Affairs, current estimates for unnecessary expenditures on overuse range from 10 to 30 percent of total healthcare spending. This indicates that a significant portion of healthcare expenses are wasted and have resulted in factors that harm patients. Misaligning financial incentives encourages physicians to do more tests and procedures while encouraging hospitals to promote services associated with higher levels of reimbursement. This rewards volume, not value.

Healthcare providers may feel pressured to perform unnecessary procedures due to financial incentives or fear of malpractice lawsuits.


In 2017, the National Institutes of Health reported that 84.7% of physicians were concerned about malpractice related to overuse: overuse spurred by precautionary measures against diagnosis uncertainty or because of patient pressure. Multiple surveys show that most Americans would prefer to die at home, yet the majority still die in the hospital, many in the intensive care unit based on 2014 Health Affairs. Unnecessary tests and procedures expose patients to potential harm, including adverse reactions to medications, hospital-acquired infections and procedural complications. 


Healthcare resources are not infinite, and overuse can lead to misallocation. This can divert attention from preventive care, public health initiatives and services for underserved populations, exacerbating existing healthcare disparities. Resource allocation imbalance means reduced access to care. When resources are overused, shortages or delays in accessing essential healthcare services can result. Overburdened facilities and healthcare providers may struggle to accommodate patients, leading to longer wait times and reduced access to timely care. 


Addressing overuse in the US healthcare system requires a shift towards value-based care, where the focus is on delivering high-quality, efficient and patient-centered services. By emphasizing evidence-based practices and incentivizing positive patient outcomes, the healthcare system can work towards a more sustainable and effective model that benefits both patients and providers. Value-based care is crucial for optimizing healthcare resources. By prioritizing value over volume, we can ensure that patients receive the necessary and appropriate treatments while reducing the healthcare system's burdens. 


The opinions expressed in this article are those of the individual author. 


Sources:

Brownlee, Shannon, et al. “When Less is More: Issues of Overuse in Health Care.” Health Affairs, 15 April 2014, https://www.healthaffairs.org/content/forefront/less-more-issues-overuse-health-care

“Overtreatment in the United States - PMC.” NCBI, 6 September 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5587107/

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