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June 18, 2008

The Perfect Storm of Overutilization

Author Affiliations

Author Affiliations: Department of Bioethics, The Clinical Center, National Institutes of Health, Bethesda, Maryland (Dr Emanuel); and Department of Economics, Stanford University, Stanford, California (Dr Fuchs).

JAMA. 2008;299(23):2789-2791. doi:10.1001/jama.299.23.2789

“A perfect storm” occurs when a confluence of many factors or events—no one of which alone is particularly devastating—creates a catastrophic force. Such confluence is rare and devastating. Over time and through disconnected events, US health care has evolved into a “perfect storm” that drives overutilization and increases the cost of health care.

The United States spends substantially more per person on health care than any other country, and yet US health outcomes are the same as or worse than those in other coutries.1,2 In 2005, the last year for which comparative statistics are available, the United States spent $6401 per person, whereas the next highest spending was in Norway and Switzerland, $4364 and $4177, respectively (Table).3,4 Overall, US health care expenditures are 2.4 times the average of those of all developed countries ($2759 per person), yet health outcomes for US patients, whether measured by life expectancy, disease-specific mortality rates, or other variables, are unimpressive (Table).1,3,4

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