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Eliminating “Waste” in Health Care

Eliminating “Waste” in Health Care COMMENTARY A conscientious clinician treating an insured patient would Victor R. Fuchs, PhD tend to recommend any intervention with a potential ben- efit greater than the potential risk. RESIDENT OBAMA IS THE MOST RECENT IN A LONG LINE Two ubiquitous aspects of medical care make identifica- of US presidents to seek reductions in health care tion of waste particularly problematic. First, there is little spending through elimination of “waste.” How- certainty in medicine. Implicitly, if not explicitly, physi- Pever, the stakes this time are unusually high—the cians are usually dealing with probabilities. Many interven- president has reported that eliminating waste is needed to tions appear to have been wasteful in retrospect, but that is fund two-thirds of the approximately $900 billion needed not the correct criterion; only prospective probability of suc- (over 10 years) for expanded health care coverage. To cess is relevant. The oft-heard promise “we will find out what achieve this goal requires defining waste, identifying con- works and what does not” scarcely does justice to the com- texts in which it occurs, determining why it occurs, and plexity of medical practice. Some interventions are undoubt- implementing policies that prevent reoccurrence. edly useless, but those that might http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Eliminating “Waste” in Health Care

JAMA , Volume 302 (22) – Dec 9, 2009

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Publisher
American Medical Association
Copyright
Copyright 2009 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.2009.1821
pmid
19996406
Publisher site
See Article on Publisher Site

Abstract

COMMENTARY A conscientious clinician treating an insured patient would Victor R. Fuchs, PhD tend to recommend any intervention with a potential ben- efit greater than the potential risk. RESIDENT OBAMA IS THE MOST RECENT IN A LONG LINE Two ubiquitous aspects of medical care make identifica- of US presidents to seek reductions in health care tion of waste particularly problematic. First, there is little spending through elimination of “waste.” How- certainty in medicine. Implicitly, if not explicitly, physi- Pever, the stakes this time are unusually high—the cians are usually dealing with probabilities. Many interven- president has reported that eliminating waste is needed to tions appear to have been wasteful in retrospect, but that is fund two-thirds of the approximately $900 billion needed not the correct criterion; only prospective probability of suc- (over 10 years) for expanded health care coverage. To cess is relevant. The oft-heard promise “we will find out what achieve this goal requires defining waste, identifying con- works and what does not” scarcely does justice to the com- texts in which it occurs, determining why it occurs, and plexity of medical practice. Some interventions are undoubt- implementing policies that prevent reoccurrence. edly useless, but those that might

Journal

JAMAAmerican Medical Association

Published: Dec 9, 2009

References