title: Systematic overuse of healthcare services: a conceptual model.
abstract: A perfect storm of factors influences the overuse of healthcare services in the USA. Considerable attention has been placed on geographic variation in utilization; however, empiric data has shown that geographic variation in utilization is not associated with overuse. While there has been renewed interest in overuse in recent years, much of the focus has been on the overuse of individual procedures. In this paper we argue that overuse should be thought of as a widespread and pervasive phenomenon that we coin as systematic overuse. While not directly observable (i.e., a latent phenomenon), we suggest that systematic overuse could be identified by tracking a portfolio of overused procedures. Such a portfolio would reflect systematic overuse if it is associated with higher healthcare costs and no health benefit (including worse health outcomes) across a healthcare system. In this report we define and conceptualize systematic overuse and illustrate how it can be identified and validated via a simple empirical example using several Choosing Wisely indicators. The concept of systematic overuse requires further development and empirical verification, and this paper provides an important first step, a conceptual framework, to that end.
authors.affiliation: Division of General Internal Medicine, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL Building Center Tower, Suite 2300, Baltimore, MD, 21224, USA, nnasser3@jhmi.edu.
authors.forename: Najlla
authors.initials: N
authors.lastname: Nassery
authors.forename: Jodi B
authors.initials: JB
authors.lastname: Segal
authors.forename: Eva
authors.initials: E
authors.lastname: Chang
authors.forename: John F P
authors.initials: JF
authors.lastname: Bridges
mesh_terms: D017048:Health Care Costs / Q000706:statistics & numerical data*; D006296:Health Services / Q000706:statistics & numerical data*; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D015233:Models, Statistical; D014481:United States