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Special Article
Health Care Reform
Jan 23, 2012

Overuse of Health Care Services in the United States: An Understudied Problem

Author Affiliations

Author Affiliations: Division of General Internal Medicine, Department of Medicine (Dr Korenstein), and Departments of Health Evidence & Policy, Obstetrics, Gynecology, and Reproductive Science, and Psychiatry (Dr Howell), Mount Sinai School of Medicine, New York, New York; Department of Emergency Medicine (Dr Falk) and Division of General Internal Medicine, Department of Medicine (Dr Keyhani), University of California, San Francisco; Departments of Public Health and Medicine, Weill Cornell Medical College, New York (Dr Bishop); and Department of Veterans Affairs Health Services Research & Development Service, Research Enhancement Award Program (REAP), San Francisco (Dr Keyhani).

Arch Intern Med. 2012;172(2):171-178. doi:10.1001/archinternmed.2011.772

Background Overuse, the provision of health care services for which harms outweigh benefits, represents poor quality and contributes to high costs. A better understanding of overuse in US health care could inform efforts to reduce inappropriate care. We performed an extensive search for studies of overuse of therapeutic procedures, diagnostic tests, and medications in the United States and describe the state of the literature.

Methods We searched MEDLINE (1978-2009) for studies measuring US rates of overuse of procedures, tests, and medications, augmented by author tracking, reference tracking, and expert consultation. Four reviewers screened titles; 2 reviewers screened abstracts and full articles and extracted data including overuse rate, type of service, clinical area, and publication year.

Results We identified 172 articles measuring overuse: 53 concerned therapeutic procedures; 38, diagnostic tests; and 81, medications. Eighteen unique therapeutic procedures and 24 diagnostic services were evaluated, including 10 preventive diagnostic services. The most commonly studied services were antibiotics for upper respiratory tract infections (59 studies), coronary angiography (17 studies), carotid endarterectomy (13 studies), and coronary artery bypass grafting (10 studies). Overuse of carotid endarterectomy and antibiotics for upper respiratory tract infections declined over time.

Conclusions The robust evidence about overuse in the United States is limited to a few services. Reducing inappropriate care in the US health care system likely requires a more substantial investment in overuse research.

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