Risks of Healthcare System Overuse
Risks of Healthcare System Overuse
Joy Stepinski, MSN, RN-BC
December 2, 2024
Self-determination is incredibly important when facing health decisions. As determined by the Commonwealth Fund, the country spends far more on healthcare (at 17.8% of the gross domestic product) than its wealthy nation counterparts [1]. Despite so much investment in healthcare, health outcomes in the United States are the worst. Being familiar with health options and asking questions about the necessity of treatment is important to avoid overuse of the healthcare system and the risks that medical care can bring.
Overuse occurs when medical services have more potential to harm patients than offer benefits [2]. While some tests and procedures may be warranted, ineffective care and treatment can lead to significant risk. Some examples discussed in the literature include unnecessary antibiotic administration (i.e, for diarrhea or viral upper respiratory infections), surgeries (i.e., 20% of hysterectomies), and cardiovascular procedures (i.e., 22% of percutaneous coronary interventions, 30% of coronary angiographies); too many screening and diagnostic tests (i.e., mammography, colonoscopies); and inappropriate aggressive treatment for patients at the end of life.
You may think, “So, what is the harm in too much treatment…?” Medical harm can lead to more medical conditions (morbidity), poor mental health, financial instability, and death. For example, patients frequently visit their primary care physician for an upper respiratory infection (URI), expecting antibiotic treatment [3]. Often, URIs are viral and do not require antibiotics. If the patient receives a prescription anyway, unwanted harm can happen, such as antibiotic resistance, adverse drug reactions, and drug interactions.
Through a random national survey, 627 practicing physicians participated in a study investigating physician views on healthcare [4]. The results showed that 42% of physicians believed their patients were receiving too much care, 28% felt that they were treated too aggressively, and 29% thought that other primary care physicians in their community ordered care that was not necessary.
According to the survey, three big factors played a role in treatment. First, 40% of doctors did not think they had sufficient time with their patients, which led to unnecessary testing. Second, 52% felt they had to comply with clinical performance measures. These quality indicators may require physicians to adhere to interventions that might not offer much benefit. Finally, 76% were concerned about malpractice.
Knowing as much as possible about your issue and the treatment offered is vital to avoid medical harm. Some questions you could ask your provider in the face of a health decision are:
1. What are you looking for?
2. What would I do differently if I had XYZ medical condition?
3. What are the risks involved with what you are recommending?
4. Can you provide a research study showing how the benefits outweigh the risks?
5. What would be the consequence if I wait and see (if the lab improves, if my symptoms get better)?
Being aware of all aspects of a health decision can lead to self-empowerment!
References:
The Commonwealth Fund. (2024). U.S. Health Care from a Global Perspective, 2022: Accelerating spending, worsening outcomes. https://www.commonwealthfund.org/publications/issue-briefs/2023/jan/us-health-care-global-perspective-2022
Brownlee, S., Chalkidou, K., Doust, J., Elshaug, A. G., Glasziou, P., Heath, I., ... & Korenstein, D. (2017). Evidence for overuse of medical services around the world. The Lancet, 390(10090), 156-168. https://doi.org/10.1016/S0140-6736(16)32585-5
Mortazhejri, S., Hong, P. J., Yu, A. M., Hong, B. Y., Stacey, D., Bhatia, R. S., & Grimshaw, J. M. (2020). Systematic review of patient-oriented interventions to reduce unnecessary use of antibiotics for upper respiratory tract infections. Systematic Reviews, 9, 1-16. https://doi.org/10.1186/s13643-020-01359-w
Sirovich, B. E., Woloshin, S., & Schwartz, L. M. (2012). Too little? Too much? Primary care physicians’ views on US Healthcare. Archives of Internal Medicine, 171(17), 1582 – 1585. https://pmc.ncbi.nlm.nih.gov/articles/PMC3184847/