Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Providing the right amount of healthcare

Thérèse A. Stukel, PhD and Noralou Roos, PhD
Policy
June 23, 2013
Share
Tweet
Share

It is easy to assume that the real problem with our healthcare system is “not enough” – not enough physicians, not enough MRIs, not enough money.

But a growing number of studies show that more healthcare is not always better and the more expensive drug or treatment option is not necessarily the right choice.  In fact, sometimes more care – specifically care that you don’t need – can be harmful for your health, and expose you to unnecessary risks.

So what is the “right amount” of care?

Getting the “right amount” of healthcare means you are getting as much care as you need, but not unnecessary, or too much, care.

Here are some examples:  Getting antibiotics for an infection caused by bacteria that is helped by antibiotics is the “right amount” of care. Getting antibiotics for a viral infection that is not helped by antibiotics – such as the common cold – would be unnecessary care.  Staying on schedule with preventive care and screening tests that are backed by evidence and recommended for your age and health condition is the “right amount” of care. Having preventive care and screening tests more often than recommended is unnecessary care.

Sounds common sense, except studies show that there is huge variation in the amount of healthcare that similar patients receive, depending largely on where they live.

For more than 20 years, the Dartmouth Atlas Project has tracked huge variations in the distribution and use of healthcare resources in the US. Studies consistently show that more care – specifically, more specialist visits, more diagnostic tests and more time in hospital, for similar patients – does not necessarily lead to better care; in fact, it could lead to harm.

By safely adopting more conservative practices, the evidence suggests that savings of about 30 percent of US Medicare costs or almost $40 billion, could be realized, with care that could be at least as good.

And in Canada?  Large regional variations have been documented in the provision of healthcare for patients with conditions such as cardiac disease, stroke, arthritis, asthma and diabetes, despite the availability of evidence-based clinical guidelines.

Less is more

Last year the Good Stewardship Working Group published ‘Top 5’ lists for primary care providers in the Archives of Internal Medicine, under the heading: “Less is More”.  They are, exactly as they sound – lists of the top five tests, medications or actions a doctor should refrain from doing unless special circumstances arise.

For example, in the top 5 list for family medicine, doctors are reminded not to order imaging tests for low back pain unless specific symptoms are present; not to routinely prescribe antibiotics for mild or moderate sinusitis unless it lasts longer than seven days or symptoms worsen after improvement; not to order annual ECGs or cardiac screening tests for low-risk patients with no symptoms of heart disease; not to perform Pap tests on patients younger than 21 years, and not to order DEXA screening for osteoporosis in women under age 65 years, and men under 70, with no risk factors.

Pediatricians are reminded not to prescribe antibiotics for pharyngitis unless a child tests positive for streptococcus; not to order diagnostic images for minor head injuries unless there is a loss of consciousness or other risk factors; to advise patients not to use cough and cold medications since there is little evidence they reduce symptoms yet have significant risks, including death.

The lists are handy references for doctors to ensure the right amount of care is being provided to the right patients.  But this doesn’t always happen as it should.

ADVERTISEMENT

Getting value for our health care dollars

A variety of factors, such as patient illness severity and physician clinical judgment, determine whether a patient receives more health services.  But non-medical factors, including a medical culture that promotes testing and interventions regardless of necessity, fee-for-service physician payment structures that reward volume over quality, excess availability of health care resources, such as hospital beds, specialists, CT and MRI scanners, and to a more limited extent, patient demand, also play a critical role.

There are limits to the amount we can spend on health care, and there is a need to determine whether we are getting good value for our health care dollars.

We need to track, for example, whether physicians in some areas are prescribing antibiotics to children much more frequently than they are in other areas – and physician groups and regional health authorities need to be tasked with asking why such high rates exist.

The same question should be asked about high rates of x-rays, EKGs, CT and MRI scans, lab tests, PSA tests, Pap smears on young girls and high rates of C-sections, hysterectomies, and other common elective surgeries.

Too much health care isn’t just costly, it is all too often bad for your health.

Thérèse A. Stukel is a professor of health policy, management and evaluation, University of Toronto, Canada.  Noralou Roos is a professor of community health services, faculty of medicine, University of Manitoba, Canada.  They are expert advisor and co-founder, respectively, Evidence Network.

Prev

Every doctor can learn from a medical coder

June 23, 2013 Kevin 16
…
Next

The future of patient-doctor emails

June 23, 2013 Kevin 14
…

Tagged as: Pediatrics, Primary Care, Public Health & Policy

Post navigation

< Previous Post
Every doctor can learn from a medical coder
Next Post >
The future of patient-doctor emails

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More in Policy

  • How locum tenens work helps physicians and APPs reclaim control

    Brian Sutter
  • Why Medicaid cuts should alarm every doctor

    Ilan Shapiro, MD
  • Why physician voices matter in the fight against anti-LGBTQ+ laws

    BJ Ferguson
  • The silent toll of ICE raids on U.S. patient care

    Carlin Lockwood
  • What Adam Smith would say about America’s for-profit health care

    M. Bennet Broner, PhD
  • The lab behind the lens: Equity begins with diagnosis

    Michael Misialek, MD
  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • Mastering medical presentations: Elevating your impact

      Harvey Castro, MD, MBA | Physician
    • Why the pre-med path is pushing future doctors to the brink

      Jordan Williamson, MEd | Education
    • Why what doctors say matters more than you think [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden incentives driving frivolous malpractice lawsuits

      Howard Smith, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
  • Recent Posts

    • Why the pre-med path is pushing future doctors to the brink

      Jordan Williamson, MEd | Education
    • Why the fear of being forgotten is stronger than the fear of death [PODCAST]

      The Podcast by KevinMD | Podcast
    • How a rainy walk helped an oncologist rediscover joy and bravery

      Dr. Damane Zehra | Physician
    • How inspiration and family stories shape our most meaningful moments

      Arthur Lazarus, MD, MBA | Physician
    • A day in the life of a WHO public health professional in Meghalaya, India

      Dr. Poulami Mazumder | Physician
    • Why women doctors are still mistaken for nurses

      Emma Fenske, DO | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 3 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • Mastering medical presentations: Elevating your impact

      Harvey Castro, MD, MBA | Physician
    • Why the pre-med path is pushing future doctors to the brink

      Jordan Williamson, MEd | Education
    • Why what doctors say matters more than you think [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden incentives driving frivolous malpractice lawsuits

      Howard Smith, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
  • Recent Posts

    • Why the pre-med path is pushing future doctors to the brink

      Jordan Williamson, MEd | Education
    • Why the fear of being forgotten is stronger than the fear of death [PODCAST]

      The Podcast by KevinMD | Podcast
    • How a rainy walk helped an oncologist rediscover joy and bravery

      Dr. Damane Zehra | Physician
    • How inspiration and family stories shape our most meaningful moments

      Arthur Lazarus, MD, MBA | Physician
    • A day in the life of a WHO public health professional in Meghalaya, India

      Dr. Poulami Mazumder | Physician
    • Why women doctors are still mistaken for nurses

      Emma Fenske, DO | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Providing the right amount of healthcare
3 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...