Overuse may be challenge to quality of health care

Underuse and overuse take place in the same communities for identical services. Meanwhile, much attention is focused on medical errors, which account for a tiny percentage of the adverse outcomes to care, he said.

He warned that many preconceptions about health-care reform are not supported by the research. For example, prevention, while a good thing, does not save money when applied across the general population. The savings come when specific preventive care is targeted to the people most at risk for a condition. So taking steps to prevent asthma attacks in children with mild asthma, in one study, cost $31 for each symptom-free day achieved. But the program for those with severe asthma saved $2.92 for every symptom-free day.

If Social Security is "the third rail" for the economy, as some have said, overuse of health-care services is "radioactive," Chassin said. But consumers see efforts to curb overuse as a benefit that's being taken away. That must change for meaningful health-care reform.

He believes "we do have the knowledge and the tools. We can create consensus-based guidelines when something is not appropriate." Consumers and doctors need to know why it's better, sometimes, for a doctor to say no. After all, he added, "insanity is doing the same thing over and over again and expecting different results."

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