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The JAMA Forum
November 14, 2017

The High Costs of Unnecessary Care

Author Affiliations
  • 1Aaron E. Carroll, MD, MS, is a professor of pediatrics at Indiana University School of Medicine
JAMA. 2017;318(18):1748-1749. doi:10.1001/jama.2017.16193

In a recent study published in PLOS One, researchers surveyed physicians across the United States to ask about their perspectives on unnecessary medical care. These physicians reported that more than 20% of overall medical care was not needed. This included about a quarter of tests, more than a fifth of prescriptions, and more than a 10th of procedures.

Of course, physicians ordered all of this care. When asked why they would do it, knowing it was unnecessary, the most common reason cited (85%) was a fear of being sued for malpractice. Research shows, though, that “defensive medicine,” as this practice known, likely accounts for far less wasted spending than we think. When physicians practice in areas with a lower risk of lawsuits, their overall practice doesn’t change that much. Another study in JAMA Internal Medicine showed that although a lot of care may be ordered in part because of defensive medicine, wasted care ordered only because of fear of lawsuits comprised less than 3% of overall costs.

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