The system of healthcare remains the pillar of a well-functioning society, having a direct contribution to the population’s well-being. However, the provision of medical services has become a complicated matter in many developed and emerging nations, especially in the United States. More specifically, the system has been experiencing the fact that its budgets and resources are finite and thus dependent on the financial performance. In this regard, an effective healthcare paradigm of the 21st century is to balance cost-efficiency and affordability, making it beneficial for both providers and recipients of services. To achieve such an outcome, medical organizations engage in a constant pursuit of new policies of cost management. One of such approaches consists of optimizing the efficiency of an institution by eliminating the unnecessary tests and procedures. In other words, its primary point suggests that patients should only receive the services that are indispensable for their specific case. This way, the resources will not be scattered across secondary procedures, keeping healthcare affordable and cost-efficient. The purpose of this paper is to examine the unnecessary care elimination as a policy of cost-containment.
As can be inferred from the title, the policy in question aims at reducing the expenditures by eliminating the unnecessary procedures often prescribed to patients. According to Carroll (2017), such unnecessary care accounts for nearly 20% of total medical services provided in the United States. The vast majority of physicians who order this care report doing so out of fear of being sued for malpractice. In other cases, patients may insist on undergoing specific procedures and tests even though they are not needed for their condition (Carroll, 2017). The purpose of the policy is to avoid such situation by encouraging physicians to refuse the services that are not required by the particular case. In addition, if a medical professional is unable to determine whether a procedure is necessary, enhanced team cooperation is promoted for better performance through combined expertise (Ralston et al., 2017). This way, an institution-wide policy provides nurses and physicians with the organizational support to make healthcare better for both hospitals and their patients.
Evidently, the effect of the discussed policy revolves around the fiscal domain of a healthcare institution. Each procedure or test prescribed to a patient enforces new expenditures on an organization. Some of them may be eventually reimbursed, but the remaining spending puts a strain on the financial performance of an organization. In this regard, the elimination of unnecessary care reduces the expenditures of a medical institution from the very beginning. As such, the reimbursement aspect is equally eliminated, reducing the hospital’s dependence on this variable (Bouck et al., 2019). Considering the twenty-percent share of unnecessary care reported above, the fiscal effect can be considerable.
On the other hand, in spite of the evident benefits for the financial management within the healthcare system, the policy’s effect on the quality of care remains uncertain. Today’s prevailing paradigm of medical services is largely patient-centered, encouraging physicians and nurses to respect the will of each individual. If the system deems unnecessary a service requested by the patient, the latter may remain dissatisfied. Thus, the patient experience will be sub-optimal, undermining one of the key criteria of the modern healthcare paradigm. In addition, certain tests may not be crucial but still contribute to a fuller understanding of the condition and minor variables that can lead to sooner improvements. If the policy in question is implemented, such procedures will not be executed.
As discussed above, the status of an unnecessary procedure is usually ascribed on the basis of a physician’s own reasoning. However, to err is human, meaning that even the most experienced professionals may overlook some issues or underestimate the importance of a specific test. In the context of healthcare, the cost of such mistakes is considerable on all levels. Many cases of serious diseases are identified during routine tests or unrelated procedures, contributing to the possibility of early treatment and prevention of complications. If the number of provided services is reduced to the absolutely necessary minimum, the likelihood of early detection will decrease accordingly. Moreover, a mistake based on the subjective reasoning will have serious repercussions, leading to readmissions and additional expenses that outweigh the initial profits.
In order to mitigate the potential unintended consequences of the policy’s implementation, it may be wise to consider the alternatives. The eternal wisdom dictates that prevention is always better than the cure. In this regard, it may be better, although more complicated, to address the problem on a deeper level through the promotion of public health. Regular screenings and affordable routine tests entail fewer expenditures, allowing communities and medical institutions to remain synchronized. Early detection on the community-wide level will enable quicker and less costly treatments, benefiting both sides. The population will enjoy better health and well-being, whereas the system will sustain fewer losses because of advanced, complicated treatment procedures. However, the full-scale implementation of the public health improvement policy will require an unprecedented degree of interprofessional cooperation, community engagement, and professional expertise.
Bouck, Z., Pendrith, S., Chen, X. K., Frood, J., Reason, B., Khan, T., Costante, A., Kirkham, K., Born, K., Levinson, W., & Bhatia, R. S. (2019). Measuring the frequency and variation of unnecessary care across Canada. BMC Health Services Research, 19.
Carroll, A. E. (2017). The high costs of unnecessary care. JAMA, 318(18), 1748-1749.
Ralston, S. L., Atwood, E. C., Garber, M. D., & Holmes, A. W. (2017). What works to reduce unnecessary care for bronchiolitis? A qualitative analysis of a national collaborative. Academic Pediatrics, 17(2), 198-204.