Deborah Korenstein, M.D., Raphael Falk, M.D., M.P.H., Elizabeth A Howell, M.D., M.P.P., Tara Bishop, M.D., M.P.H., and Salomeh Keyhani, M.D., M.P.H.
Overuse of health care services contributes to poor-quality care and drives up medical costs. Because of challenges in identifying and documenting overuse, however, the concept has been little studied in U.S. health care. Commonwealth Fund–supported researchers conducted a literature review to better understand the scope of overuse and spot trends over time.
Based on a database search for articles published between 1978 and 2009, the authors identified 172 studies measuring rates of overuse. Of these, 53 related to therapeutic procedures, 38 related to diagnostic tests, and 81 related to medications. The most commonly studied services were: use of antibiotics for upper respiratory infections (59 studies), coronary angiography (17 studies), carotid endarterectomy (13 studies), and coronary artery bypass grafting (10 studies). While rates of overuse for particular services varied among the studies, the review found that overuse of carotid endarterectomy and antibiotics have declined over time.
The authors conclude that overuse of services is a common but not well understood problem. Further research is needed to help fill in gaps, particularly those related to newer and often costly procedures and tests. "Expanding the evidence base and establishing appropriateness criteria for a broader range of services could help target and eliminate overuse in health care services, which could reduce health care spending without adversely impacting the health of the public," they conclude.