Factors Associated With Overuse of Health Care Within US Health Systems
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RESULTS … Health systems that were primarily investor owned had an Overuse Index (OI) that was 0.56 standard deviations [SD] higher than those that were not investor owned. … Health systems in the upper third of primary care physicians, upper third of teaching intensity, and upper quarter of uncompensated care had an OI that was lower by 0.59 SD, 0.45 SD, and 0.47 SD, respectively.
CONCLUSIONS AND RELEVANCE In this cross-sectional study of US health systems, higher amounts of overuse among health systems were associated with investor ownership and fewer primary care physicians.
Comment by: Jim Kahn of PNHP: “Low-value care” refers to medical services for which the potential for harm far outweighs the potential for benefit. There has been a huge effort in medicine over the past 10 years to identify and reduce this unwise overuse of care, because it wastes resources (which would be better used for individuals with too little care!) and harms patients (due to procedure side effects). But changing provider behavior is difficult. Old patterns die hard, and the challenge is greater if the wrong incentives are in place.
The Segal team studied all Medicare patients and health systems. They compared features of the health systems with use of 17 low-value services (such as MRI for routine low back pain, nasal endoscopy for sinusitis, hysterectomy for benign disease, and meniscus removal for degenerative knee joint). They found that primarily investor-owned health systems had more low-value care. This may harm patients, but presumably yields nice profit margins.
A higher concentration of primary care physicians was associated with less low-value care, consistent with the patient-centered orientation of primary care. The study also found less low-value care with more medical teaching (with a focus on keeping up with the best recent evidence) and more uncompensated care (presumably due to restricted opportunities to profit from unnecessary procedures).
Single payer would eliminate investor-owned health systems and would incentivize primary care. It would also use reimbursement rules to encourage higher quality and more efficient medical practice. All of these factors would mean less low-value care, which would mean money redirected to real care needs and no patient harm from contra-indicated interventions.
Jesus: Hey, Dad? God: Yes, Son? Jesus: Western civilization followed me home. Can I keep it? God: Certainly not! And put it down this minute--you don't know where it's been! Tom Robbins in Another Roadside Attraction
January 24, 2022 at 2:27 PM #467514djean111Participant
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The new “direct contract” that Medicare has introduced, and 53 insurance companies have started participating in this year, means that insurance companies will get a lump sum per patient and get to keep whatever they do not spend. Good-bye to overuse, hello to “try and get any fucking health care”. The aim, for starters, is to discourage referrals to specialists, and having the primary doctor try and address everything. Cheers!
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