Despite Prevalence of Unnecessary Health Care, Few Question Doctors

For a variety of economic, legal and cultural reasons, Americans frequently receive care that will provide them little to no benefit.  According to estimates, the U.S. health care system wastes between $250-$325 billion annually on unnecessary care; $6.8 billion of that is spent on 12 common unnecessary tests and treatments.

We’re seeing some efforts in the health care system to reign in unnecessary spending.  In April, a multi-specialty panel of physicians released a set of recommendations against 45 tests and procedures in a report described as "an unusually frank acknowledgment by physicians that many profitable tests and procedures are performed unnecessarily and may harm patients."

Such recommendations are promising, but their adoption may be another matter altogether. Doctors report pressures from patient expectations, potential malpractice risk, revenue concerns and time limitations (it takes longer to explain why a test is unnecessary than to order it) that discourage them from taking action. Thus, any significant reduction in unnecessary care will not likely come from new practice recommendations, but from patient demands for appropriate care.

To explore how consumers feel about this issue, the Altarum Center for Consumer Choice in Health Care Team asked a question in our semi-annual national survey of consumers (see the report here).  We asked whether respondents agreed with this statement: 

My doctor would never recommend a test or procedure if it wasn’t necessary.

To our surprise, only 6 percent disagreed with this statement; 76 percent agreed and 18 percent were neutral. Apparently, the general perception is that if someone is getting unnecessary care, it does not come from the doctor.

Given that unnecessary care should be a national priority for both financial and safety reasons, this over-estimate of the appropriateness of “my” care should cause concern.  Some (if not most) of the pressure to avoid unnecessary and/or harmful services must come from the intended recipients of those services. 

Consumers will have to routinely ask – Why do I need that?  What will it do for me? What are the risks?–  instead of simply trusting that our doctor is one of the few who never orders, prescribes, or performs services we might not need. Yet based on these findings, few perceive a need to question the necessity of the care they receive.

Helping consumers realize the role they can play to improve safety and reduce cost will require consistent messages.  A good example is the recent blog series in the New York Times by Tara Parker Pope called “Too Much Medical Care?” chronicling stories of unnecessary piling-on of tests and medications in cases that often started with minor illness or injury.  It may take many such messages – in which people recognize their own similar experiences – for more of us to understand that, yes, unnecessary care does happen. Even with our own doctors.

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