Agree with the bolded, but multiple articles you posted made that exact statement. So you're kind of arguing against your own sources. I can't even find any legitimate studies which compare the prevalence/incidence of CAD among various countries right now, but my point was simply that the more cases of emergent exacerbations of CAD, the more caths will take place. Considering that 1 and 6 deaths in the US are attributable to cardiovascular disease, I think most people would argue that we're actually under-treating the condition. I realize it's more complex than that, but it also depends on what you consider to be acceptable outcomes.
It is simple. If the patient does not meet the criteria to have cath performed and has it performed it is overutilization.
Hospital Variability in the Rate of Finding Obstructive Coronary Artery Disease at Elective, Diagnostic Coronary Angiography - ScienceDirect
"Our study found marked variation in the institutional rate of finding obstructive CAD among patients undergoing elective diagnostic cardiac catheterization, which was stable over time at each center. This variation was predictable based on the characteristics of the patients selected for the procedure and their pre-catheterization evaluation, testing, and treatment. Centers with a
low rate of finding obstructive CAD undertook procedures on patients who were younger, had a lower likelihood of disease, and who were less likely to have had a noninvasive evaluation demonstrating ischemia before coronary angiography. Finally, modeling suggests that up to
one third of elective, diagnostic cardiac angiograms might not be required if low CAD rate centers were able to adopt similar patient selection, treatment, and testing patterns as currently practiced in those institutions with the highest rates of finding CAD."
Neither of which were accounted for in the statistics of the article you provided, only hospital costs, so my point still stands.
(25+ x(where x<25))/2= still less than 25
I do understand what it entails, according the article which I read in its entirety, what I quoted was later referenced in terms of overutilization, not access. If you have a problem with my quote, you have a problem with your source. How much of the care is actually warranted, beneficial, or efficacious is based on standard hospital protocols and EBM of when a patient needs to receive treatment. You don't just put someone on a beta blocker or diuretic for funsies. Same goes for procedures and caths. I'm not saying it never happens, but I'm just not convinced that there is some epidemic of over-treatment when patients didn't meet criteria for that treatment. I can see why that would be for imaging or testing in terms of defensive medicine and not wanting to miss something, but not treatment. If you want to argue that protocol and standards aren't efficient, I think that would be more reasonable, but I'm unconvinced after reading your sources that treating when not indicated is the biggest issue in healthcare.
The IOM says that it is a larger cost then administrative bloat and you dont think its the largest issue.
This is the source you keep on qouting. Look at what it defines as overutilization. It is clearly displaying that just number of physicians hospital beds/discharges overuse in their minds. And in the next sentence they are attributing to cost per stay , What do you think is contributing to that cost per stay? It is things like overuse of caths and testing that does not add value.
"U.S. Has Below-Average Supply and Utilization of Physicians, Hospitals Beds Another commonly assumed explanation for higher U.S. health care spending is that the utilization or supply of health care services in the U.S. must be greater than in Exhibit 3. Explaining High Health Care Spending in the United States: An International Comparison 5 other countries. OECD data suggest, however, that this assumption is unfounded, at least when it comes to physician and hospital services.
There were 2.4 physicians per 1,000 population in the U.S. in 2009, fewer than in all other study countries except Japan. Likewise, patients had fewer doctor consultations in the U.S. (3.9 per capita) than in any other country except Sweden (Exhibit 4). Hospital supply and use showed similar trends, with the U.S. having
fewer hospital beds (2.7 per 1,000 population), shorter lengths of stay for acute care (5.4 days), and fewer discharges (131 per 1,000 population) than the OECD median (Exhibit 4). Exhibit 5, however, shows that hospital stays in the U.S. were far more expensive than in the other study countries, exceeding $18,000 per discharge compared with less than $10,000 in Sweden, Australia, New Zealand, France, and Germany.
This could indicate that U.S. hospital stays tend to be more resource-intensive than in other countries or that the prices for hospital services are higher."
To the bolded, that is as much of a societal problem as it is a medical one. If you tell someone in the U.S. that we have a medication for their disease, but it's not that efficacious, most of them will demand to try it if they can afford it. How many news stories have you seen about how little Timmy didn't get the $10,000/day treatment for his terminal cancer even though it would only extend his life by weeks and the family is outraged? Because I literally see them a few times per month. It's the same problem we have with end of life care here. People often expect that everything be tried, regardless of whether or not it will make a legitimate and significant difference.
There are literally hospitals in the same zip code that have large variations in the the intensity of care, the overuse of procedures, etc. Sure cultural aspects are at play but we cannot wash our hands of this mess either. Plus what about all the harm that is caused by stuff like that, these procedures are not without risk.
As for tort reform, you have to look at how it affected those states on an individual level. In Texas, malpractice cases dropped by more than 50% after it was implemented in the early 2000's. Additionally they're one of the 5 lowest states in the country in terms of malpractice award payout per capita (behind North Dakota, Minnesota, and Wisconsin). So I'm not sure where you're seeing that it doesn't work in Texas unless you're looking at raw numbers, which is silly. In Cali, MICRA has worked extremely well for malpractice since the 70's. At the same time states that overturned caps and limited the reform like Missouri and Georgia have gotten significantly worse in terms of cost of medical malpractice in recent years (Missouri had 126 million in payouts pre-reform in 2005, then dropped to below 40 million for several years, then bounced back up to almost 70 million when caps were removed, and now are declining again with re-implementation of caps). Plus culture of the states matter. Minnesota has minimal tort reform, yet does great, but as a whole the state of Minnesota has fewer lawsuits than almost every state in every aspect of the law. So it's not as necessary there. Meanwhile, the worst states in the country (IL and NY), are a bunch of litigious a-holes with minimal to no reform.
So while I don't think reform is going to be the thing that saves healthcare expenditure by any means, it's a necessary step in the right direction in many places.
The point was that if tort reform was the sole driver of overutilization cya medicine etc , it would not persist in texas.Yet it still exists in texas. Medical spending has not decreased in texas even if lawsuits have decreased.
