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Survey: Fear of Malpractice Drives Most Overuse of Healthcare Resources

Most wasted healthcare resources and costs in the United States are related to unnecessary medical services, according to a new study. The price tag? About $210 billion a year.

A new survey of more than 2,000 physicians across multiple specialties sought to determine why overtreatment occurs. Results were published recently in PLOS ONE.

The Johns Hopkins School of Medicine-led research found that physicians consider overuse of healthcare resources to be common and most often spurred by fear of malpractice, although patient demands and profit motives play some role.

"Unnecessary medical care is a leading driver of the higher health insurance premiums affecting every American," explained senior author Martin Makary, MD, MPH, professor of surgery and health policy at Johns Hopkins.

Noting that overtreatment can led to patient harm, Makary pointed out that decreasing treatment improves patient safety and reduces healthcare costs.

The Johns Hopkins research team, part of a national consortium exploring ways to reduce unneeded care, invited 3,318 physicians to complete a survey about healthcare practices. The list was derived from a continuing education subgroup of the American Medical Association's Physician Masterfile, a database of more than 1.4 million physicians in the United States.

Ultimately, 2,106 physician responses were included in results of the survey, which was conducted between Jan. 22 and March 8, 2014.

Most respondents said they believed at least 15% to 30% of medical care provided was not needed.

In a breakdown of that response, considered unnecessary were:

  • 22% of prescription medications;
  • 24.9% of medical tests;
  • 11.1% of procedures;
  • 20.6% of overall medical care delivered.

The median response for physicians who said they perform unnecessary procedures for profit motive was 16.7%. More likely to believe that physicians perform unnecessary procedures for profit were physicians with at least 10 years of experience, after residency and specialists.

"Interestingly, but not surprisingly, physicians implicated their colleagues — more so than themselves — in providing wasteful care. This highlights the need to objectively measure and report wasteful practices on a provider or practice level so that individual providers can see where they might improve," noted co-author Daniel Brotman, MD.

Top reasons for overuse of resources, according to survey respondents, were fear of malpractice, 84%; patient pressure/request, 59%; and difficulty accessing prior medical records, 38.2%.

When asked about potential solutions, physician participants suggested better training for medical residents on appropriateness criteria for care (55.2%), easier access to outside health records (52%), and more evidence-based practice guidelines (51.5%).

"Most doctors do the right thing and always try to. However, today, ‘too much medical care’ has become an endemic problem in some areas of medicine. A new physician-led focus on appropriateness is a promising homegrown strategy to address the problem," Makary said.