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Editorial
October 7, 2019

Waste in the US Health Care System—Insights For Vision Health

Author Affiliations
  • 1Quality and Data Science, American Academy of Ophthalmology, San Francisco, California
  • 2Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
JAMA Ophthalmol. Published online October 7, 2019. doi:10.1001/jamaophthalmol.2019.4647

In 1998, the Institute of Medicine defined 3 problems in health care quality: underuse, misuse, and overuse.1 The Institute of Medicine Committee on Better Care at Lower Costs estimated that in 2009, about 30% (or roughly $750 billion) was wasted on excessive administrative expenses, fraud, unnecessary services, and other causes.2 This fueled efforts to identify duplicative and unnecessary costs and separate low-value care from high-value care. In 2012, Berwick and Hackbarth3 pointed out that the best strategy to reduce costs and still meet the needs of the public for high-quality care was to reduce waste, estimating that the lower end of potential savings was more than 20% of total health care spending. An analysis4 of 2014 medical claims in Virginia found that a high volume of low-value services (costing $538 or less) accounted for the bulk of unnecessary costs.

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