Author Affiliations: Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts (Dr Kassirer), and Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, California (Dr Milstein).
After decades of attention to unsustainable growth in health spending and its degradation of worker wages, employer economic vitality, state educational funding, and federal fiscal integrity, it is discouraging to contemplate fresh evidence by Welch et al1 of our failure to curb waste of health care resources. These wide geographic variations in the frequency of repeated diagnostic testing persist more than 30 years after the first salient description of wide geographic variation in health service use.2 Most subsequent studies that embedded increasingly refined risk adjustment have failed to find evidence of superior treatment outcomes in high-use regions. Even after finer calculations shrink prior estimates of some regional variations,3 few in medicine or health policymaking dispute the benefit of curbing higher regional rates of testing and treatment that confer no detectable clinical benefit.
Kassirer JP, Milstein A. Our Failure to Curb Excessive Testing Comment on “Repeat Testing Among Medicare Beneficiaries”. Arch Intern Med. 2012;172(22):1751-1753. doi:10.1001/jamainternmed.2013.1780