Salomeh Keyhani, Raphael Falk, Elizabeth A. Howell, Tara Bishop, and Deborah Korenstein
S. Keyhani, R. Falk, E. A. Howell et al., “Overuse and Systems of Care: A Systematic Review,” Medical Care, June 2013 51(6):503–8.
Rising health care costs have focused attention on reducing the overuse of health care services, which, according to one estimate, accounted for up to $226 billion in unnecessary spending in 2011. Misaligned incentives and the fee-for-service payment system are thought to be significant drivers of overuse of health care.
In their Commonwealth Fund–supported review of the published literature, the researchers found no consistent indication that any particular system of care or insurance―whether fee-for-service or managed care―has been more effective than another in minimizing overuse of health care services. For example:
Despite an increased focus on overuse in recent years, “this attention has not translated into tangible investment in overuse measures,” the authors say. Given that the VA and managed care organizations have in the past successfully incorporated performance measures to reduce underuse of preventive care and improve chronic disease management, they should also be able to support efforts to reduce overuse “if relevant performance measures were developed and if national reporting created an incentive to decrease rates of overuse.”