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Barriers, opportunities to end ‘more is always better’

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Rita F. Redberg, M.D., and Deborah G. Grady, M.D., write in MedPage Today about the barriers to ending “more is always better” mindset  of clinicians and consumers in U.S. healthcare.

Many procedures and treatments currently being used  have no known benefit.

They note how “Less healthcare stirs fears of rationing, or withholding care simply to save money….Doctors and health systems may earn more money when they do more.”

“We felt that focusing on the harms of overuse and the benefits of less healthcare might counter these forces and educate Americans that there are also often good reasons to ‘withhold’ care.”

“Unfortunately, awareness of the harms of overuse of medical care probably isn’t enough to achieve the ‘less is more’ goal. {But} we are very encouraged to see that many new efforts are underway to reduce overuse, including educational initiatives, computer-based alerts, and decision support tools, peer review and feedback, and system changes supported by implementation and behavioral sciences.

“Important changes are also occurring in the U.S. healthcare system, moving us away from fee-for-service medicine, which rewards high-volume care regardless of appropriateness, towards bundled payments, Accountable Care Organizations, and capitated systems that can better align incentives towards high-value care.”


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