Avoidable Health Spending
- Fraud and abuse
- Avoidable care
- Medical errors
- Practice variations
- Ambulatory care sensitive conditions
- Cost-ineffective care
- Excess regulatory costs
- Excess administrative costs
The Institute of Medicine analyzed health spending for 2009, showing that the U.S. health system wastes an estimated $765 billion (30% of annual health spending), including $210 billion in unnecessary services, $190 billion in paperwork/unnecessary administrative services, $130 billion on inefficiently delivered services, $75 billion on fraud, $55 billion on missed prevention opportunities.
There is substantial variation in the level of inappropriate use across different health care services. Research shows that the rates at which particular procedures, tests, and medications were performed or prescribed when clinically inappropriate ranged from a low of 1 percent to a high of 89 percent.
- Fraud and Abuse Issue Summary & Web Links (HealthHippo)
- Fraud Web Links (St. Louis University School of Law)
- National Council Against Health Fraud
- Fraud and Abuse (William L. Manning links)
- Medicare Fraud (Whistleblowerfirm.com)
- False Claims Act (Quackwatch.org)
- Program Integrity: How Much Money Can Combating Health Care Fraud and Abuse Save? (Alliance for Health Reform)
- Berenson, Robert A. and Docteur, Elizabeth, Doing Better by Doing Less: Approaches to Tackle Overuse of Services (January 5, 2013). Timely Analysis of Immediate Policy Issues (RWJF/Urban Institute), January 2013 . This paper provides a summary of the problem of overuse in the U.S. health care system. The analysis gives an overview of the provision of medically inappropriate and unnecessary services that drive up health care spending without making a positive impact on patients’ health outcomes. It also describes approaches that have already been used to address overuse of health care services and outlines the broader payment reforms needed to minimize incentives to overdiagnose and overtreat.
- Variations (Health Affairs topics page)