Physicians taking part in a recent survey said 20.6% of overall medical care and about 22% of prescription medications given in the United States are unnecessary.
A large majority of those polled said that the fear of malpractice allegations was a leading cause of unnecessary services, researchers wrote in PloS One.
“Unnecessary medical care is a leading driver of the higher health insurance premiums affecting every American,” researcher Martin Makary, MD, MPH, a professor of surgery and health policy at the Johns Hopkins University School of Medicine, said in a news release. “Most doctors do the right thing and always try to. However, today ‘too much medical care’ has become an endemic problem in some areas of medicine. A new physician-led focus on appropriateness is a promising home-grown strategy to address the problem.”
The survey included responses from 2,106 physicians practicing in primary care and various specialties. They were asked what percentage of overall care, medications, procedures and other interventions conducted in the U.S. they believed were unnecessary.
They were also asked what they believed were the top reasons for unneeded care, if they felt such a problem existed, and what should be done to remedy that, among other questions.
Aside from responses regarding unneeded overall care and prescriptions, physicians believed 24.9% of tests and 11.1% of procedures were unwarranted. In addition, 30% of respondents believed that at least 30% to 45% of prescription medications were unnecessary.
The three most common reasons given for unneeded care were the fear of malpractice, pressure or requests from patients and difficulty obtaining patients’ records — cited by 84.7%, 59% and 38.2% of physicians, respectively.
About 71% said they felt that physicians were more likely to conduct unneeded procedures when they stood to profit from them.
The three most common possible solutions to unneeded care chosen by respondents were training residents on appropriateness of care (55.2%), easy access to patient records (52%) and an increase in practice guidelines (51.5%).
A strong majority — 76% — said they believed that de-emphasizing fee-for-service bonus pay would reduce unneeded care.
The researchers said the responses suggest a need for training to avoid unwarranted care that can harm patients and waste money and resources. They noted several existing programs with that aim while stressing the need for further progress.
“Future work should focus on the most high-volume over-utilized tests and procedures by specialty,” they wrote. “Medical school and training should include guidance on the subject of appropriateness before doctors are exposed to the factors identified in this study as factors contributing to the problem.” – by Joe Green
Disclosure: The researchers report no relevant financial disclosures.