Wasteful Medical Spending — January 2017

Wasteful Medical Spending — January 2017


Is There Anything You Can Do?

It is widely documented that the U.S. spends more on healthcare per person than any other country, yet much research shows that Americans are not healthier as a result. Wasteful spending accounts for 30 percent of the $3.2 trillion spent on healthcare each year. That’s $960 billion of waste per year! While this may seem like a challenge too large, there are ways to do your part to reduce wasteful spending.

What Is Healthcare Waste?

Healthcare waste is a complex problem. It occurs for a variety of reasons, including over-treatment, under-treatment, failures of care delivery, and a lack of care coordination.

Over-treatment usually means unnecessary treatment. It can be ineffective (providing no health benefit), lead to the need for additional treatment, and even cause harm. Over treatment includes delivering care that is based on outdated practices instead of scientific findings or prescribing medications when lifestyle changes are proven to work. Examples include treating viral illnesses, like colds, with antibiotics and treating pre-high blood pressure (138/89 or less) with medications before trying to lower blood pressure through diet and exercise.

Under-treatment occurs when effective services are not delivered, increasing the chance that more expensive services will be needed later. For example, preventive healthcare visits can help identify potential concerns, from detecting cancer at early stages to preventing disease with vaccination. Preventing conditions means avoiding the cost of treating them. Under-treatment can also occur among people who suffer from chronic pain. Many sufferers have difficulty finding a provider to manage their pain in light of recent concerns about misuse/abuse of prescription pain medications. However, proper pain management can significantly improve quality of life, and prevent the need for other health services.

Waste can also result from failures of care delivery. When providers do not adopt best practices (such as preventive care) or safety protocols that reduce exposure to harm, patients are at risk for worsened health, injuries and higher costs.

Similarly, when care is poorly coordinated, waste can add up. Patients who visit multiple doctors are at greater risk for uncoordinated, fragmented care, which has been linked to higher rates of hospitalization, frequent emergency room visits, multiple surgeries, duplicative lab testing, as well as lower satisfaction with care. Besides the extra cost of more medical services, there is also the potential for harm, for example, exposure to unnecessary radiation from extra scans (X-ray, CT scan) when previous results are available.


What Can You Do?

Individuals can’t fix the national healthcare problem, but there are important steps you can take to make your use of healthcare more efficient and effective. First, find a primary care provider who you like and trust. Talk with him or her about your health to make sure you get the right amount of care (not too much or too little). Before having any test, treatment or procedure, ask your provider these questions (adapted from the Choosing Wisely campaign):

  1. Do I really need this test or procedure? Asking this question helps clarify that the suggested test will provide useful information about how to treat a concern or how a procedure will treat a problem. Ask if previous test results can be used before submitting to additional testing.
  2. What are the risks? Will there be side effects? What are the chances of receiving false-positive results (inaccurate results)? Could that lead to more testing or another procedure?
  3. Are there simpler, safer options? Sometimes lifestyle changes can solve or improve healthcare concerns.
  4. What happens if I don’t do anything? Ask if your condition could get worse, or better, if you wait and watch.
  5. How much does it cost and are there less expensive options? For example with medications, generic drugs are often equally effective but at a lower cost.

It’s hard to imagine buying a gallon of milk or a refrigerator without first knowing their cost. But with healthcare, it is often difficult to know what a doctor’s visit, procedure or service will cost before you “buy” it. As a consumer of healthcare services, you have resources to help you choose wisely, minimize waste, and reduce your out-of-pocket expenses.

Your KnovaSolutions nurse can assist you with making important healthcare decisions custom-fit for your particular situation. In addition, these sites offer helpful information:

  • Costs for medical services can vary depending upon where you live and the facility where care is delivered. These tools provide fair price information and estimate medical/dental costs in your area. Healthcare Blue BookFair Health, U.S. National Library of Medicine.
  • Compare hospital ratings here and here.
  • Consumer Reports compares features offered by insurers to help their users find out the costs of services, which doctors accept your insurance, etc.
  • Resources about common healthcare topics, some in Spanish, from Choosing Wisely.

See Our Other Newsletters

For more information about being a smart consumer of healthcare services, read these past newsletters:

Know Your Out-Of-Pocket Costs

When Is It Necessary? Reducing Medical Testing, Risks and Expense

For more information about healthcare waste and making effective decisions about your health, contact your KnovaSolutions nurse at 800/355-0885, M-F, 8 am-5 pm.

We encourage you to leave a comment or question below and a KnovaSolutions nurse or pharmacist will reply.

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The information contained in this newsletter is for general, educational purposes. It should not be considered a replacement for consultation with your healthcare provider.  If you have concerns about your health, please contact your healthcare provider.


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