title: Evidence for overuse of medical services around the world.
abstract: Overuse, which is defined as the provision of medical services that are more likely to cause harm than good, is a pervasive problem. Direct measurement of overuse through documentation of delivery of inappropriate services is challenging given the difficulty of defining appropriate care for patients with individual preferences and needs; overuse can also be measured indirectly through examination of unwarranted geographical variations in prevalence of procedures and care intensity. Despite the challenges, the high prevalence of overuse is well documented in high-income countries across a wide range of services and is increasingly recognised in low-income countries. Overuse of unneeded services can harm patients physically and psychologically, and can harm health systems by wasting resources and deflecting investments in both public health and social spending, which is known to contribute to health. Although harms from overuse have not been well quantified and trends have not been well described, overuse is likely to be increasing worldwide.
authors.affiliation: Lown Institute, Brookline, MA, USA; Department of Health Policy, Harvard T.H. Chan School of Public Health, Cambridge, MA, USA. Electronic address: sbrownlee@lownistitute.org.
authors.forename: Shannon
authors.initials: S
authors.lastname: Brownlee
authors.affiliation: Institute for Global Health Innovation, Imperial College, London, UK.
authors.forename: Kalipso
authors.initials: K
authors.lastname: Chalkidou
authors.affiliation: Center for Research in Evidence-Based Practice, Bond University, Gold Coast, QLD, Australia.
authors.forename: Jenny
authors.initials: J
authors.lastname: Doust
authors.affiliation: Lown Institute, Brookline, MA, USA; Menzies Centre for Health Policy, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Adam G
authors.initials: AG
authors.lastname: Elshaug
authors.affiliation: Center for Research in Evidence-Based Practice, Bond University, Gold Coast, QLD, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Glasziou
authors.affiliation: Royal College of General Practitioners, London, UK.
authors.forename: Iona
authors.initials: I
authors.lastname: Heath
authors.affiliation: The World Bank, Phnom Penh, Cambodia.
authors.forename: Somil
authors.initials: S
authors.lastname: Nagpal
authors.affiliation: Lown Institute, Brookline, MA, USA.
authors.forename: Vikas
authors.initials: V
authors.lastname: Saini
authors.affiliation: LSE Health, London School of Economics and Political Science, London, UK.
authors.forename: Divya
authors.initials: D
authors.lastname: Srivastava
authors.affiliation: Menzies Centre for Health Policy, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Kelsey
authors.initials: K
authors.lastname: Chalmers
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Korenstein
mesh_terms: D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D014943:Global Health / Q000706:statistics & numerical data*; D006300:Health Services Misuse / Q000706:statistics & numerical data* / Q000639:trends; D006302:Health Services Research; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data; D009626:Terminology as Topic