Quality care is the primary goal of healthcare providers. Multiple regulations, measures, and reimbursement models are utilized to promote a high level of patient care and improve outcomes.

Sometimes, though, medical treatment is given, even though it’s not necessary. This results in overtreatment, which is a cause of preventable harm and waste. Waste in the United States healthcare system can be categorized as administrative, operational or clinical.

The American Academy of Family Physicians (AAFP) defines overtreatment as treatment initiated when there is little or no reliable evidence of a clinically meaningful net benefit, where net benefit equals benefit minus harm. A previous study of more than 2,000 physicians found that almost two-thirds of doctors believe that at least 15–30% of medical care is unnecessary. According to the study, the most common reasons for overtreatment are fear of malpractice, patient demands and difficulty accessing prior medical records.

Common Causes of Overtreatment

Why do some physicians over-treat? There are likely multiple reasons. One is that research shows that doctors often overestimate how much care their patients really want. Another is that there is an incentive for the health industry to boost revenue, sometimes to help pay for expensive testing equipment.

An article in the Journal for Healthcare Quality theorized that patients who do not understand procedures are unlikely to question a physician's recommendation, whereas doctors are also unlikely to question specialists' recommendations. The article also discusses the term “medical overuse,” which it describes as unwarranted or unnecessary delivery of care unlikely to improve outcomes or services an average patient would opt to forgo given choices.

It’s estimated that unnecessary or unneeded tests and procedures cost the U.S. healthcare system $282 million annually. Using the Institute of Medicine’s (IOM’s) estimate of excess costs arising from overtreatment, a 50% reduction in unnecessary services would result in $105 billion in savings each year.

Low-Value Healthcare Services

One component of overtreatment is low-value healthcare services (LVHS), which are procedures that provide little or no clinical benefit. The overuse of LVHS is common in the U.S., leading to waste and suboptimal patient outcomes. Examples of low-value care include:

  • Running lab tests for low-risk patients before a low-risk procedure
  • Ordering head CT scans for simple dizziness or an EEG for a headache
  • Using costly branded drugs instead of identical generics
  • Performing surgery when physical therapy would be equally effective
  • Inappropriately prescribing antibiotics

Another facet of overtreatment is overdiagnosis, which occurs when an actual abnormality is discovered, but the detection of it and its treatment does not benefit the patient. Typical instances of overdiagnosis include:

  • Imaging for low back pain or headaches
  • Antibiotics for upper respiratory tract infection
  • Dual-energy X-ray absorptiometry (used to measure bone mineral density)
  • Preoperative testing (electrocardiography, stress electrocardiography, chest radiography) in low-risk patients
  • Antipsychotics in older patients
  • Artificial nutrition in patients with advanced dementia or advanced cancer
  • Proton pump inhibitors in gastroesophageal reflux disease
  • Urinary catheter placement
  • Cardiac imaging in low-risk patients
  • Some cancer screening (cervical smear test, CA125 antigen for ovarian cancer, prostate-specific antigen screening, mammography)
  • Use of cesarean section without medical indication

Consequences of Overtreatment

There are consequences to overtreatment beyond cost and waste. It can result in physical, financial and emotional harm for patients and also lead to false positives, unnecessary follow-ups, increased patient anxiety, along with decreased satisfaction and poor outcomes.

Overtreatment also is directly associated with patient harm, as evidenced by studies of antibiotic overuse leading to resistance and Clostridium difficile infection, overuse of diagnostic testing and the inherent postoperative complications from unnecessary surgical procedures. Other potential consequences of both overdiagnosis and overtreatment are unnecessary treatment negatively affecting quality of life and psychological and behavioral effects of disease labeling.

The Choosing Wisely initiative offers lists for physicians and patients of more than 300 of the most commonly overused and expensive medical procedures.

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Overtreatment in Healthcare: a Harmful and Prevalent Problem