It seems as though some doctors may be milking their better-insured patients. In fact, a recent study published in JAMA Internal Medicine suggests that more than $750 billion of U.S. health care spending annually represents waste, including approximately $200 billion in overtreatment. Keep in mind, that a person treating under the California workers’ compensation system is a “better-insured” patient since they do not have any policy limit and no deductible.
This study examines low-value health care spending among US adults ages 18 to 64 years using data from Optum Clinformatics Datamart of UnitedHealthcare commercial claims for 2011 to 2013.
Data from 2013 insurance claims, which included nearly 1.5 million adults with commercial insurance, showed that just under eight percent of people had received “low-value services,” meaning they provided little value to patients given all the costs and alternatives.
The most commonly received low value services included: triiodothyronine measurement in hypothyroidism (1.5%), imaging for nonspecific low back pain (1.3%), and imaging for uncomplicated headache (1.0%). The greatest proportion of spending was for spinal injection for lower-back pain at $12.l million (37.0%), head imaging for uncomplicated headache at $3.6 million (11.0%), and imaging for nonspecific low back pain at $3.1 million (9.4%)
“The important caveat to highlight is, we’re only looking at 28 services. We’re looking at a very small slice, but it can give you a lens on the larger problem,” said Rachel Reid, lead author and a policy researcher at RAND Corporation to CNN.
In a previous report published in The National Academies of Sciences – Engineering – Medicine, a study found that the U.S. spends more on healthcare than any other nation. In 2009, health care costs reached $2.5 trillion, nearly 17 percent of the GDP. Yet, despite this spending, health outcomes in the U.S. are considerably below those in other countries.
It was also discovered that low-value spending was less among patients who were older, male, black or Asian, lower income, or enrolled in a Consumer-Directed Health Plan. Regionally, the Southern, Middle Atlantic, and Mountain regions had greater proportionate low-value spending
What happens when a patient asks for a specific test? Should a doctor refuse? “What are you supposed to say – no?” says Dr. Jane Orient, executive director of the Association of American Physicians and Surgeons, to CNN. “Failure to diagnose is one of the most common reasons for filing a lawsuit, so there is a lot of pressure [on doctors], if you think of something, to do it,” according to Dr. Orient.
Ideally, the California workers’ compensation Utilization Review and Independent Medical Review process will screen for and refuse authorization for low value care. And current and future amendments to the Medical Treatment Utilization Schedule will continue to identify what is considered by evidence based medicine to be low value care.