Overuse, Misuse of Care. Duplication, overuse or inappropriate care—sometimes the result of our fragmented health system—contribute to high costs in the United States. U.S. adults are more likely to report that medical records and test results are not available when needed, and that tests are duplicated or unnecessary. Care that is not evidence-based, such as imaging tests for lower-back pain with no apparent risk factors or signs of serious pathology, adds unnecessarily to costs.

Too Many Admissions and Readmissions. Inadequate access to primary care, whether during regular office hours or after-hours, contributes to expensive visits to the emergency room or admission to the hospital. Americans are more likely to report use of emergency rooms for conditions that could have been treated by a primary care physician, if available. Hospitalization for potentially preventable conditions such as congestive heart failure, diabetes, and pediatric asthma vary two- to four-fold. Bringing national rates of preventable hospitalizations down by 10 percent to 20 percent could save $4 billion to $8 billion annually.