Overtreatment

Read it this way Overtreatment or low-value care, highlighted, is only the fourth-largest of six categories at up to 101.2 billion dollars, well behind administrative complexity at 265.6 billion and pricing failure at up to 240.5 billion. This argues against treating clinical overtreatment as the main driver of the 760 billion to 935 billion dollar total. The larger dollars sit in administrative and pricing failure. Use this chart to distinguish more care from better care, and to see why the recommendation targets high-intensity, low-benefit utilization rather than across-the-board cuts.

Shrank, Rogstad, and Parekh, Waste in the US Health Care System, JAMA · 2019 · source

Read it this way More than half of Medicare cataract patients, 53.0 percent, received pre-op testing the guidelines advise against, and even the lowest rate shown, imaging for low-back pain at 27.2 percent, means more than one in four eligible patients got a discouraged service. These four bars come from separate studies with different populations and years, not one representative sample of all low-value care. Use this chart to distinguish more care from better care, and to see why the recommendation targets high-intensity, low-benefit utilization rather than across-the-board cuts.

Peer-reviewed low-value-care studies (Tan 2015, Fleming-Dutra 2016, Chen 2015, Kim 2022) · 2011 to 2018 · source

Read it this way The midpoint traces 750 billion dollars in 2009, a dip to 734 billion in 2011, then a rise to 847.5 billion in 2019, but because each point comes from a separate study with its own definitions and methods, read this as three independent snapshots agreeing waste is large and persistent, not as a smooth continuous trend. Use this chart to distinguish more care from better care, and to see why the recommendation targets high-intensity, low-benefit utilization rather than across-the-board cuts.

Caveat Each study used different data years, category definitions, and methods, so read these as three snapshots of a persistently large estimate, not a smooth trend.

IOM 2012, Berwick and Hackbarth 2012, Shrank et al 2019 · 2009 to 2019 · source

Read it this way The spread from Miami at 13,678 dollars down to Santa Cruz at 7,967, a 1.72-fold difference, is fully adjusted for price and demographics, so it reflects care-intensity choices rather than sicker patients or higher local prices. Only the file's named extreme regions are plotted, so this shows the range of variation, not where a typical middle-of-the-pack region falls. Use this chart to distinguish more care from better care, and to see why the recommendation targets high-intensity, low-benefit utilization rather than across-the-board cuts.

Caveat Only the file's named extreme regions carry values. A full map of all 306 regions is not in this dataset.

Dartmouth Atlas of Health Care, Geographic Variation · 2018 · source

Read it this way McAllen's 61.0 visits per decedent versus Ogden's 11.2, about a five-fold difference, echoes the same pattern the spending chart shows: more intensity with no documented survival gain. These are 2011 figures for the file's listed extreme regions only, and the national average had already fallen to 26.3 by 2018, so the true gap today may be narrower than this snapshot suggests. Use this chart to distinguish more care from better care, and to see why the recommendation targets high-intensity, low-benefit utilization rather than across-the-board cuts.

Caveat These are the file's 2011 endpoint regions. Per-region 2018 values are not in the dataset. The national average fell from 28.8 in 2011 to 26.3 in 2018.

Dartmouth Atlas of Health Care, Geographic Variation · 2011 · source

Read it this way New inpatient consults and inpatient visits show the widest gaps, at 2.36 and 2.13 times the low-spending regions, while ICU days and inpatient days sit lower but still clear the equal-intensity line at 1.0. This chart shows utilization rate ratios only. Whether that extra care improved outcomes is what the next chart answers, not this one. Use this chart to distinguish more care from better care, and to see why the recommendation targets high-intensity, low-benefit utilization rather than across-the-board cuts.

Fisher et al., Regional Variations in Medicare Spending, Annals of Internal Medicine · 2003 · source

Read it this way Every cohort's relative risk sits at or barely above 1.0, from 1.003 for hip fracture to 1.012 for colorectal cancer, meaning a 10 percent spending increase bought no measurable survival benefit in any group studied. The general-population confidence interval of 0.99 to 1.03 crosses 1.0, so that estimate alone cannot rule out a true effect of zero. Use this chart to distinguish more care from better care, and to see why the recommendation targets high-intensity, low-benefit utilization rather than across-the-board cuts.

Caveat Values cluster at 1.0 by the design of the finding. The exact relative risks and 95 percent confidence intervals are in the table below.

Fisher et al., Regional Variations in Medicare Spending, Annals of Internal Medicine · 2003 · source