ArticleApplied health economics and health policy2015
Systematic overuse of healthcare services: a conceptual model.
Article in Applied health economics and health policy, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
26 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Development of a Conceptual Map of Negative Consequences for Patients of Overuse of Medical Tests and Treatments.JAMA internal medicine · 2018Pooled it
- Factors Influencing Overuse of Breast Cancer Screening: A Systematic Review.Journal of women's health (2002) · 2018Pooled it
- Article
- Covert Triage During the COVID-19 Pandemic: A Qualitative Analysis of Rationing in Intensive Care.Chest · 2025Article
- Cervical Cancer Screening Overuse Among Women With and Without Disability in the U.S. From 2007 to 2016.AJPM focus · 2025Article
- Article
- Procedure code overutilization detection from healthcare claims using unsupervised deep learning methods.BMC medical informatics and decision making · 2023Article
- Admission and Care Practices in United States Well Newborn Nurseries.Hospital pediatrics · 2023Article
- The TRIBE model: How socioemotional processes fuel end-of-life treatment in the United States.Social science & medicine (1982) · 2023Review
- The impact of global budget payment reform on systemic overuse in Maryland.Healthcare (Amsterdam, Netherlands) · 2020Article
- Defensive practice is indefensible: how defensive medicine runs counter to the ethical and professional obligations of clinicians.Medicine, health care, and philosophy · 2020Article
- Conceptualizing and Counting Discretionary Utilization in the Final 100 Days of Life: A Scoping Review.Journal of pain and symptom management · 2020Article
- Understanding Geographic Variation in Systemic Overuse Among the Privately Insured.Medical care · 2020Article
- Use and overuse of diagnostic neck ultrasound in Ontario: Retrospective population-based cohort study.Canadian family physician Medecin de famille canadien · 2020Article
- Physician and Patient Characteristics Associated With More Intensive End-of-Life Care.Journal of pain and symptom management · 2019Article
- Systemic overuse of health care in a commercially insured US population, 2010-2015.BMC health services research · 2019Article
- Observational
- Do doctors who order more routine medical tests diagnose more cancers? A population-based study from Ontario Canada.Cancer medicine · 2019Article
- Policy package for preventing overuse and underuse of health care services in the Iranian health care system: A study protocol.Medical journal of the Islamic Republic of Iran · 2019Article
- Regional Supply of Medical Resources and Systemic Overuse of Health Care Among Medicare Beneficiaries.Journal of general internal medicine · 2018Article
Corrections and comments
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Authors and funding
4 authors.
Funding
Abstract
A perfect storm of factors influences the overuse of healthcare services in the USA. Considerable attention has been placed on geographic variation in utilization; however, empiric data has shown that geographic variation in utilization is not associated with overuse. While there has been renewed interest in overuse in recent years, much of the focus has been on the overuse of individual procedures. In this paper we argue that overuse should be thought of as a widespread and pervasive phenomenon that we coin as systematic overuse. While not directly observable (i.e., a latent phenomenon), we suggest that systematic overuse could be identified by tracking a portfolio of overused procedures. Such a portfolio would reflect systematic overuse if it is associated with higher healthcare costs and no health benefit (including worse health outcomes) across a healthcare system. In this report we define and conceptualize systematic overuse and illustrate how it can be identified and validated via a simple empirical example using several Choosing Wisely indicators. The concept of systematic overuse requires further development and empirical verification, and this paper provides an important first step, a conceptual framework, to that end.
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