A recent analysis highlights waste and missed opportunities to improve outcomes.


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It's well known that the United States spends more on health care than other countries yet fails to achieve those countries' success. Numerous studies have documented this, including a January 2020 report from the Commonwealth Fund that compared data from 10 high-income countries. Life expectancy in the United States is shorter, hospitalization rates for preventable causes such as diabetes and hypertension are among the highest, and the burden of chronic disease is much greater than in countries such as France, Australia, Germany, and Canada.


Another recent analysis in the American Journal of Public Health sought to quantify the money wasted in the United States on medical care that doesn't improve people's health or well-being and suggest ways it could be put to better use. The report found that, even at the lowest estimates, wasteful spending amounts to $600 to $900 billion annually in 2019 dollars, with top-end estimates as high as $1.9 trillion. The research team concluded that redirecting this money into investments in public health, safety, and social support programs could yield significant population health benefits.


The researchers identified six categories of wasteful spending: fraud and abuse, clinical inefficiency, missed prevention opportunities, overuse, administrative waste, and excessive prices. An example referenced in the report of waste across several of these categories was the U.S. failure to invest in pandemic preparedness-despite warnings-and the subsequent lack of a coordinated public health approach to containing the spread of COVID-19, which so far has caused the deaths of more than half a million Americans.


The report's stated purpose is to increase awareness among health care practitioners and policy makers of the breadth and causes of wasteful medical spending and stimulate action to recapture and deploy the money to programs with genuine public benefit. For example, the money lost to fraud and abuse alone ($185 billion) could cover "annual estimated costs to provide free tuition at public colleges and universities ($79 billion), universal child care ($42 billion), universal pre-K ($26 billion), and partial wage replacement for up to 12 weeks of family leave ($28 billion)," the authors write.


Acknowledged limitations of the analysis include data sources from different time periods and scant data from recent years following implementation of the Affordable Care Act.


All of the waste areas identified in the report are amenable to nursing interventions. For example, the category "overuse," which encompasses procedures and treatments with little health benefit, accounts for an estimated $451 billion in wasteful spending. Nurses can minimize unnecessary use of supplies and advocate for and with patients against unnecessary treatments via patient education. Nurses can also participate on purchasing committees, start quality initiatives, and join governing boards. For more examples of what nurses can do, visit Choosing Wisely (http://www.choosingwisely.org), an initiative that "seeks to advance a national dialogue on avoiding unnecessary medical tests, treatments and procedures."-Gail M. Pfeifer, MA, RN


Speer M, et al Am J Public Health 2020;110(12):1743-8; Tikkanen R, Abrams MK. New York, NY: Commonwealth Fund; 2020 Jan 30.