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Understanding Geographic Variation in Systemic Overuse Among the Privately Insured
Allison H Oakes1,2, Aditi P Sen1,2, Jodi B Segal1,2,3
1Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health.
Medical Care
|February 28, 2020
Summary
Healthcare system structure drives medical overuse. Interventions should target systemic factors, not individual procedures, to reduce patient harm and wasteful spending.
Area of Science:
- Health Services Research
- Health Economics
- Medical Care Quality
Background:
- Medical care overuse leads to significant patient harm and financial waste.
- Understanding the root causes of overuse is crucial for developing effective interventions.
Purpose of the Study:
- To investigate the association between healthcare delivery system structures and regional variations in systemic overuse.
- To identify specific regional healthcare characteristics linked to overuse patterns.
Main Methods:
- Retrospective analysis of deidentified claims data for adults aged 18-64 (January 2011-June 2015).
- Calculation of the Johns Hopkins Overuse Index for 375 US Metropolitan Statistical Areas.
- Ordinary least squares regression modeling to link the Overuse Index with regional healthcare system characteristics.
Main Results:
- Physician supply (per 1000 residents) and Medicare malpractice geographic price cost index were associated with increased overuse.
- Higher density of primary care physicians and a greater proportion of hospital-based providers correlated with decreased overuse.
- Market power of hospitals and insurers showed an inverse relationship with systemic overuse.
Conclusions:
- Systemic overuse is demonstrably linked to observable, structural aspects of regional healthcare systems.
- Interventions to enhance care efficiency by reducing overuse should prioritize addressing these structural drivers.
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