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Stubborn Underuse and Overuse Are Global Healthcare Problems

By Tinker Ready  
   January 12, 2017

Overuse and underuse are persistent symptoms of a profoundly dysfunctional healthcare system immune to incremental reforms, say the authors of an exhaustive study.

The overuse of health services is old news. In the US, the problem emerges in the form of variations in practice patterns and overdiagnoses. Here, underuse usually falls under the heading of access.

In both cases, efforts are underway to expand coverage and discourage the use of low-value services.

But the worldwide problem of inappropriate care described in a series of research papers released Monday goes beyond anything that could be addressed through quality measures or The Affordable Care Act.

The 27 researchers who contributed to the series published in The Lancet see overuse and underuse as symptoms of a profoundly dysfunctional healthcare system immune to incremental reforms.

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They make their case in a series of four articles that describe the problem, identify causes, and call for systemic change. They sum up their findings this way: "Because poor care is ubiquitous and has considerable consequences for the health and well-being of billions of people around the world, remedying this problem is a morally and politically urgent task."

In a related commentary, Donald Berwick, MD, president emeritus and senior fellow at the Institute for Healthcare Improvement, describes the research as a "call-to-arms to improve health care globally by better matching care to needs, and practice to science."

The authors met on Monday in London to discuss the findings. One of them, Lown Institute president Vikas Saini, MD, spoke to HealthLeaders Media last week in his organization's Boston-area office.

The Lown Institute, which inspired and shepherded the research, is working to spark a grassroots movement "to transform the health system," he said.

Tinker Ready is a contributing writer at HealthLeaders Media.

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