Health Policy$ense

Regional and Temporal Patterns in Overuse of Medical Care

Persistent patterns provide insight

Allison H. Oakes, PhD, is an advanced fellow in health services research at the Center for Health Equity Research and Promotion at the Crescenz VA Medical Center and the Penn Medicine Nudge Unit, and an LDI Associate Fellow.

Overuse of medical care—the provision of services that can do more harm than good—remains a key driver of waste in our health care system. While most work on this topic has focused on individual overused services, we think it is valuable to conceptualize overuse as a systemic phenomenon, defined as the general tendency of an organization or region to overuse medical services. It turns out that regions and organizations have persistent patterns of overuse, and we’re beginning to understand why.

In our recent work, my colleagues and I map out the distribution of systemic overuse in commercially-insured adults across regions and across time (2011-2015), identifying structural differences in regional health care delivery systems with greater overuse.

To measure systemic overuse, we created an index of 19 low-value service indicators. These “bellwether” services capture 11 unique clinical areas—primary care practice, otolaryngology, radiology, cardiology, neurology, emergency practice, allergy, oncology, urology, physical therapy, and surgery. We applied this index to a large national claims database for adults with employer-sponsored health insurance.

In our first paper, we found that systemic overuse was lower in rural regions of states than in metropolitan areas. Examples of high overusing metropolitan regions include areas in Washington, California, Texas, Louisiana, Florida, New Jersey, and New York. There was relatively little overuse in the central and northwestern parts of the US. These geographic patterns are similar those seen in the Medicare population.