What makes health costs so much higher in America? It’s not overuse…

In the US, we spend much more on health care than other developed countries, but we have worse health outcomes — why? A new study in JAMA gives a detailed comparison of metrics from 11 high-income countries that challenges the conventional wisdom on what makes the US health cares system different.  

The researchers found that key drivers of health care costs in the US compared to other high-income countries are prices and administrative costs. The US also ranks high in utilization of expensive imaging tests like MRIs and CT scans, and specific surgical procedures, like knee replacements and C-sections. However, patients in the US did not go to the doctor or hospital more than patients in other countries.

Reducing unnecessary care is the not the solution to our country’s health care cost problem. That doesn’t mean it isn’t worth doing.

These findings echo some of the research we’ve seen before, including a report from the Commonwealth Fund that shows that overuse of medical technology and prices together contribute to high health spending in the US. But what the headlines about this new study claim is that unnecessary care is not the problem. Not so fast.

We’ve argued on this blog that it’s the dangerous combination of overuse and high prices that drive our health care costs. Because the prices of many tests, drugs, procedures, and physician services are often disconnected from their value, we underutilize basic, inexpensive, preventive care and overutilize expensive, often unnecessary services. 

Setting aside overuse of certain specific procedures, overall overuse does not appear to be increasing US health care costs more than in other developed countries. For those of us who are striving to reduce low-value care in our institutions and communities, this should make us rethink how we frame the issue of overuse.

Overuse, and the increase in costs from overuse, is not a uniquely American problem.

There are two key points here. The first is that overuse, and the increase in costs from overuse, is not a uniquely American problem. We know from previous research, led by the Lown Institute and published last year in The Lancet, that both overuse and underuse are international problems. We should be looking for partnerships with international organizations studying overuse and lessons from other countries on best practices in reducing unnecessary services.

The second is that fixing overuse is not a panacea. Reducing unnecessary care is the not the silver bullet solution to our country’s health care cost problem. However, that doesn’t mean it isn’t worth doing. Getting rid of unnecessary services will likely save some money, and we should be looking to reduce our health costs where we can. As study author Dr. Ashish Jha points out in a New York Times article

“It’s not that we’re buying more pizzas, we’re just paying more for each pie. But that doesn’t mean that you can’t still buy fewer pizzas.”

More importantly, we know that overuse causes real harm to patients, not just wasted money. Overprescription of unnecessary medications leads to adverse drug events and hospitalizations; false positives from overtesting can lead to overtreatment and complications that affect quality of life; our high c-section rate risks womens’ health; the list goes on and on.

The patient harm caused by overuse is reason enough to keep researching the effectiveness of tests and procedures, facilitating shared decision making conversations between doctors and patients, and pushing back against the medical culture of “more is better.” We also have to do something about high prices if we want to control health care costs.