Overtreatment is one of the major critical issues of health systems all over the world. It imposes a heavy burden on the shoulders of both individual patients and societies. It is rooted in overdiagnosis which happens when people are diagnosed with non-harmful conditions, leading to unnecessary treatments that can cause more harm than good.

Overtreatment, in the strict sense, may refer to unnecessary medical interventions, including treatment of a self-limited condition (overdiagnosis), or to extensive treatment for a condition that requires only limited treatment. It poses a physical, psychological and economic burden on patients who expect their pain and suffering to be relieved by healthcare services. Since every medical procedure is accompanied by a probable risk of side effects, any superfluous treatments would add to the level of potential adverse effects. Moreover, excessive payment for unnecessary treatments equals decreased patient welfare and a lower ability to pay for food, shelter, education and leisure. Overtreatment also places the burden of knowing, anxiety of risk and an increased sense of vulnerability on patients. However, the importance of problems caused by overtreatment could be considered much higher in a societal perspective and the potential increase in the cost of health insurance is one of its most damaging effects. A journalistic estimation reveals that in the United States, where healthcare costs are the highest as a percentage of GDP, overutilisation is the major factor in its expense, accounting for about a third of healthcare spending in the US ($750 billion out of $2.6 trillion).

As stated by Jack Wennberg, leading researcher of unwarranted variation in the healthcare industry, “suppliers [are] more important in driving demand than had been previously realized”. Providing unnecessary treatments is closely related with a concept in health economics called “supplier-induced demand” (SID). SID points to the amount of demand for healthcare that exists beyond what would occur in a health market in which patients are fully informed. On the other hand, overuse of medical services could be traced to a culture of more-care-is-better-care. This cultural aspect points to the demand side of the healthcare market in which patients and their families might seek more services than what they actually need. Improving knowledge and health literacy would expectedly mitigate overuse of healthcare and clinical services. Furthermore, for better understanding of the causes of overtreatment, commercial healthcare determinants should be taken into account. Overtreatment by medical services seems to be in line with the interests of pharma companies and this is another difficult aspect of the issue that needs special attention from health policy makers for market regulation.

Ali Kazemian
Patient Advocate Inspire2Live