Health care is expensive. Anyone who has accessed health care services knows just how expensive it is and health care costs have continued to increase for decades. In 2012, spending on health care services totaled about $2.8 trillion, about $8,915 per person, and accounted for 17.2 percent of the nation’s Gross National Product (GDP).
After a recent ease in medical costs, health care costs are expected to continue to outpace economic growth. Actuaries from the Centers of Medicare and Medicaid predict that by 2021 spending for health care services will account for about 20 percent of the nation’s GDP. The increase in spending is attributed to the expansion of the Affordable Care Act (more people will have access to health care) and an improving economy. With an improved economy, more people will be choosing to access health care because they have the resources to spend.
But another contributing factor to the increase of medical costs is medical overuse is also worthy of discussion. Medical overuse is “provision of medical services with no benefit or for which harm outweigh benefit.” Some estimate that up to 30 percent of health care spending to be a result of medical overuse and the Institute of Medicine estimates that about $210 billion a year is spent on medical overuse. Some contributing factors to medical overuse may be financial incentives some physicians receive and marketing efforts that are designed to create a demand for more testing, diagnosis, and treatment.
To help stem the trend of medical overuse, both physicians and patients need to understand that more is not always better when it comes to health care interventions. Some interventions that are done “just to be safe” are not only unnecessary, but can be costly and can also cause harm to the patient. Medical overuse will not decrease until there is a change of culture in medicine and a change in attitude about medical errors and uncertainty. There is currently an “intolerance of error and culture of blame” regarding how health care services are provided. This has caused physicians to argue for the need to practice defensive medicine because of the threat of malpractice.
To help combat medical overuse, the Choosing Wisely campaign was implemented in 2012 by the American Board of Internal Medicine (ABIM). This campaign is working to “spark conversations between providers and patients to ensure the right care is delivered at the right time.” The campaign promotes communication between providers and between providers and their patients. The Choosing Wisely campaign uses the same concept as evidence-based guidelines to encourage specialists to agree on a list of interventions that should be used and ones that would be unnecessary as a means to eliminating waste and overuse.
This campaign provides an opportunity for health communicators to get involved. Given that the campaign is focused on reaching both providers and health care consumers, we can play a role on both fronts. We have the opportunity to work with physicians to help them understand their role in medical overuse and how their current practices need to and can change. And we also have the chance to work with patients and help them understand the lack of benefit and potential harm of receiving medical interventions that are unnecessary.