Waste and overuse

I read this paper recently and then reread it (subscription probably required); this I think is destined to become a classic. It touches on subject matter to which I have alluded in recent posts, Quality is goodness, Choosing Wisely and Waste and healthcare costs. The authors set out to examine the extent to which overuse of healthcare resources, defined as inappropriate diagnostics, treatments and medications has been studied. The results were striking in a very negative sense. Medline was searched for a period of 21 years, and a total of 172 papers were found which examined some aspect of overuse:

"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)" 

In other words, 172 papers have sought to determine the extent of waste attributable to overuse (in the US healthcare system) out of >114,000 evaluated. Just to re-emphasise, some authorities estimate that waste contributes to 20-30% of US healthcare expenditure and we appear not to have even begun to systematically examine the extent of the problem. Even where the work has been done, it appears the papers are limited to a few main areas, including angiography, CABG, cartotid endartectomy, antibiotics for respiratory infections etc. Not that it is an easy thing to study, but surely government funding agencies should be in these challenging times insisting that more efforts be put into studying these areas rather than focussing on the next addition to our medical arsenal.