Quality Care: Doing the Necessary, Reducing Waste
Healthcare professionals strive to deliver high-quality care. Multiple policies, measurements, and reimbursement methods are used to encourage high-quality patient treatment and improve outcomes. We are currently experiencing fascinating medical advances and therapeutic breakthroughs for several diseases. Success stories increase patients’ expectations of treatment and cure. However, medical innovation is complex and a challenge for our healthcare systems.
The responsible use of healthcare resources is critical to its stability. Responsibility does not imply reduction of benefitial services. Acting responsibly entails focusing on essential and scientifically effective medical interventions. However, due to economic incentives in the healthcare industry and overuse of the system by patients who lack health literacy and are not supplied with the knowledge they require, medical care is provided even when it is not required.
This results in overtreatment, which causes avoidable patient harm and unnecessary expense.
Common Causes of Overtreatment
Overtreatment is defined as medical intervention provided when there is little or no substantial evidence of clinically meaningful benefit, or when the benefit is less than the risk. But why do some physicians overtreat patients? Several explanations are likely.
- Research indicates that doctors often overestimate how much care their patients actually desire.
- Increased diagnostic procedures or excessive therapeutic efforts can also be a manifestation of defensive medicine: In settings where physicians face heightened threats of malpractice lawsuits and claims for damages, more diagnostics and therapies than necessary are prescribed as a precautionary measure.
- Additionally, there are financial incentives within the health care sector to increase revenue, which can sometimes help cover the costs of expensive diagnostic equipment.
According to a US survey of over 2,000 physicians, about two-thirds feel that at least 15-30% of medical care is unnecessary. The most often cited causes for overtreatment were fear of malpractice (84.7%), patient pressure or request (59.0%), and difficulties accessing medical data (38.2%). The majority of respondents (70.8%) stated that doctors are more prone to do unneeded procedures when they profit from them.
Overtreatment Threatens Healthcare Stability
It is estimated that wasteful or unnecessary tests and treatments cost the United States’ healthcare system $282 million each year. Using the Institute of Medicine’s (IOM) estimate of extra expenses due to overtreatment, a 50% decrease in unneeded treatments would result in $105 billion in annual savings. In Australia, it has been calculated that the three largest “payer” groups, the federal government, state governments, and private health insurers, pay for approximately $30 billion of ineffective and inappropriate care each year – care for which a cheaper alternative, or no treatment at all, would be just as effective. German hospitals and doctors are potentially endangering their patients’ health by talking them into expensive treatments and unnecessary operations, according to an investigation by the SOCIUM research center at Bremen University.
Also, the UAE’s healthcare system faces several challenges. As stated recently by Dr Nigel Umar Beejay, Consultant Physician Gastroenterologist Hepatologist at Emirates Hospital Day Surgery Clinic Abu Dhabi, even with the implementation of the Diagnosis-Related Group (DRG) system in Dubai and Abu Dhabi, there remains a considerable amount of duplication in testing, leading to overdiagnosis and unnecessary treatments. In addition, a lack of health literacy among the population hinders effective disease prevention and management. Misconceptions fueled by biased information on social media exacerbate this issue.
Overtreatment May Harm Patients
Let us give you a well known example: Back pain is one of the major common ailments, most of us will be confronted with during our lives. But surgery is only required in very specific cases. The German fact check on back pain, however, shows that surgical procedures due to back complaints were increasing dramatically and were performed with varying frequency depending on the patients’ place of residence. In some region patients were 13 (!) times more likely to undergo a spine surgery than in other locations. The strong regional differences can, according to the researchers, only be attributed to a small extent to objective factors such as the number of orthopedists in the area. They are also not due to the fact that people have more frequent back problems. The fact check cites: “The increase in procedures and the regional differences are also related to the preferences of the local doctors.” This much-discussed statement implies that in some German hospitals medical procedures are undertaken for personal and economic reasons rather than medical necessity.
There are consequences to overtreatment beyond cost and waste. It can result in physical, financial and emotional harm for patients and also lead to false positives, unnecessary follow-ups, increased patient anxiety, along with decreased satisfaction and poor outcomes.
Focus on Necessary Medical Measures
How can we focus: The risk of overtreatment is best reduced by matching treatments to persons at higher risk of disease progression due to age or other risk factors, rather than applying “one size fits all” care that can unnecessarily treat lower-risk patients. To minimize potential harm, it is equally important to avoid aggressive treatments in persons with limited life expectancy and little expected benefit. Since overdiagnosis often drives overtreatment, screening should target populations or high-risk subgroups where early intervention is proven beneficial.
Medically necessary treatments, examinations, or measures are those required to diagnose, treat, or alleviate a condition, and serve as the basis for health insurance coverage. A medical measure is essential when:
- it is appropriate and beneficial, addressing the health concern without exceeding what is necessary,
- and it follows established medical standards and guidelines.
Avoiding aggressive therapies for patients unlikely to benefit—such as opting for palliative care over curative treatment—is not “giving up,” but rather “doing the right thing at the right time,” focusing on the best possible outcome and quality of life.
Assessing medical necessity is critical for both insured persons and insurance companies. Covering only medically necessary treatments protects individuals from excessive costs and unnecessary services, while ensuring transparency and security in case of illness. For insurers, medical necessity helps control healthcare expenses and maintain stable premiums.
Independent Medical Assessment – A TheKnowHow Service
If required, health insurance companies may obtain an external medical assessment to clarify whether a treatment is medically necessary, thereby providing additional security for patients. In this instance, it appears reasonable to rely on independent specialists who have not been engaged in the patient’s previous or future care. This ensures an unbiased assessment for the patient’s benefit, free of misleading economic incentives.
TheKnowHow independent medical assessment evaluate whether medical procedures and therapies adhere to the most recent recommendations made by scientific guidelines. Have clinical trials demonstrated their safety and efficacy? Exist less obtrusive options? Our team of experts at TheKnowHow works remotely and record-based. They must not be involved in the subsequent treatment of patients ensuring their unbiased objective assessments of medical conditions and treatment options.
While our priority is always to provide a thorough and impartial assessment founded on the most current global research and clinical expertise of each case, we work efficiently and collaboratively with our clients and deliver our services promptly. As a standard practice, we strive to provide our reports within a few working days.
Investing in an independent medical assessment is worthwhile: It helps to save unnecessary healthcare expenses and keep potential harm from unnecessary treatments away from your clients.
Talk to us! Let us support you in providing the best care to your clients.
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