title: Eliminating waste in US health care.
abstract: The need is urgent to bring US health care costs into a sustainable range for both public and private payers. Commonly, programs to contain costs use cuts, such as reductions in payment levels, benefit structures, and eligibility. A less harmful strategy would reduce waste, not value-added care. The opportunity is immense. In just 6 categories of waste--overtreatment, failures of care coordination, failures in execution of care processes, administrative complexity, pricing failures, and fraud and abuse--the sum of the lowest available estimates exceeds 20% of total health care expenditures. The actual total may be far greater. The savings potentially achievable from systematic, comprehensive, and cooperative pursuit of even a fractional reduction in waste are far higher than from more direct and blunter cuts in care and coverage. The potential economic dislocations, however, are severe and require mitigation through careful transition strategies.
authors.affiliation: donberwick1@gmail.com
authors.forename: Donald M
authors.initials: DM
authors.lastname: Berwick
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Hackbarth
mesh_terms: D003363:Cost Control; D017046:Cost Savings; D003695:Delivery of Health Care / Q000191:economics*; D017598:Efficiency, Organizational; D005607:Fraud / Q000517:prevention & control; D017048:Health Care Costs; D019981:Health Care Sector / Q000458:organization & administration*; D005102:Health Expenditures / Q000706:statistics & numerical data; D008484:Medicaid / Q000191:economics; D006278:Medicare / Q000191:economics; D017146:Models, Organizational; D010347:Patient Care Planning; D058991:Patient Protection and Affordable Care Act; D014481:United States; D019564:Unnecessary Procedures