Can’t Get Over Overuse
In the movie Casablanca, Police Captain Renault announces with feigned surprise that he “shocked” to find out that gambling is going on at Rick’s Casino.
If you needed proof that yes, overuse of health services is going on here in the U.S., it comes in a new study out last week. It reports with alarm that over overuse of therapeutic procedures accounts for as much as 30% of healthcare spending in our nation.
The article, published in the current issue of the Archives of Internal Medicine, reported on a review of 241 separate studies of overuse published between 1978 and 2009. Overuse was defined as interventions in which negative consequences, including unnecessary costs, outweighed the benefits of care.
The 4 most common health services examined in the studies included in the review were antibiotics for upper respiratory infections, coronary angiography, carotid endarterectomy, and coronary artery bypass grafting and revascularization.
One healthcare service that appeared to be significantly overused was follow-up screening colonoscopies, with up to a 60.8% rate of overuse; also hysterectomy, at up to 70.0% overuse.
“Despite broad acknowledgment that overuse is common and costly, overuse research has been underemphasized compared with research on underuse of health services,” the authors write.
Captain Renault attempted to deal with the gambling “problem” by closing Rick’s Casino for one night, thus averting a fight between the Free French citizens and Major Strasser and her evil Nazi thugs.
Here in the U.S., one attempt to quantify and reduce overuse is the new Patient-Centered Outcomes Research Institute (PCORI) which issued its much anticipated first report on national priorities on January 23.
The 22-page report stopped short of specifying any diseases or conditions that would be targeted for comparative effectiveness research.
Instead it made a series of general statements, intended to “define the boundaries” and “define the types of questions that we want to invest in,” said one panel member.
In Casablanca, Humphrey Bogart was forced to abandon the girl (Ingrid Bergman) and along with Claude Rains (Captain Renault), was forced to flee the city, heading for a French army camp deep in the North African desert. An initial setback for the two men, but “the beginning of a beautiful friendship,” said Bogart.
Let us hope the PCORI panel members maintain their sense of optimism as they begin a long struggle against the huge problem of overuse which may generate opposition from some entrenched interests.
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