|
Unnecessary health care (overutilization, overuse, or overtreatment) is health care provided with a higher volume or cost than is appropriate. In the United States, where health care costs are the highest as a percentage of GDP, overuse is the predominant factor in its expense. Factors that drive overuse include paying health care providers more to do more (fee-for-service) and covering patients' costs by a third-party (public or private insurance) payer. These factors leave both doctors and patients with no incentive to restrain health care prices or use.〔〔 Overtreatment in the strict sense may refer to unnecessary medical interventions, including treatment of a self-limited condition (overdiagnosis), or extensive treatment for a condition that requires only limited treatment. ==Definition== A forerunner of the term was what Jack Wennberg called unwarranted variation: different rates of treatments based upon where people lived, not clinical rationale. He had discovered this in studies that began in 1967, published in the 1970-1980's. "The basic premise-that medicine was driven by science and by physicians capable of making clinical decisions based on well-established fact and theory-was simply incompatible with the data we saw. It was immediately apparent that suppliers were more important in driving demand than had been previously realized."〔Michael T. McCue (Clamping down on variation ) - Managed Healthcare Executive, February 01, 2003〕 In 2008, bioethicist Ezekiel J. Emanuel and health economist Victor R. Fuchs defined unnecessary health care as "overutilization" or health care provided with a higher volume or cost than is appropriate.〔 In 2009 two physicians wrote in an editorial, that unnecessary care was "defined as services which show no demonstrable benefit to patients", and might represent 30% of U.S. medical care.〔 〕 They referred to a 2003 study on regional variations in Medicare spending, which found that "Medicare enrollees in higher-spending regions receive() more care than those in lower-spending regions, but () not have better health outcomes or satisfaction with care".〔Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 2: health outcomes and satisfaction with care. Ann Intern Med. 2003; 138:288-98.PMID: 12585826〕 In January 2012, the American College of Physicians Ethics, Professionalism, and Human Rights Committee suggested that overtreatment can also be understood in contrast to 'parsimonious care', defined as "care that utilizes the most efficient means to effectively diagnose a condition and treat a patient".〔 Snyder L; American College of Physicians Ethics, Professionalism, and Human Rights Committee. American College of Physicians Ethics Manual: sixth edition. Ann Intern Med. 2012;156(1, pt 2):73-104.PMID:22213573, doi: 10.7326/0003-4819-156-1-201201031-00001.〕 In April 2012, Don Berwick from the Institute for Healthcare Improvement and Andrew Hackbarth from the RAND Corporation defined overtreatment as "subjecting patients to care that, according to sound science and the patients’ own preferences, cannot possibly help them — care rooted in outmoded habits, supply-driven behaviors, and ignoring science". They wrote that trying to do something (treatment or testing) for all patients who might need it inevitably entails doing that same thing for some patients who might not need it". In uncertain situations "some nonbeneficial care was the necessary byproduct of optimal clinical decision making."〔Berwick DM, Hackbarth AD. Eliminating waste in US health care.JAMA. 2012 Apr 11;307(14):1513-6. doi: 10.1001/jama.2012.362. 〕 In October 2015, two pediatricians said that, looking at "overtreatment as an ethical violation" could help see the conflicting incentives of health care workers for treatment or non treatement. 〔Shawn L. Ralston, Alan R. Schroeder. (Doing More vs Doing Good: Aligning Our Ethical Principles From the Personal to the Societal ). JAMAPediatrics October 19, 2015 doi:10.1001/jamapediatrics.2015.2702 〕 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「unnecessary health care」の詳細全文を読む スポンサード リンク
|