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These key factors are driving overuse of healthcare


A study of hundreds of healthcare systems identified common characteristics. Some factors relate to size and ownership, researchers say.

Overuse of healthcare can drive up costs and hurt patients, and a new study sheds light on the factors driving the problem.

The study, published in the Journal of the American Medical Association, identifies some common characteristics of systems that are more likely to demonstrate overuse.

Researchers from Johns Hopkins University developed an “Overuse Index” consisting of 17 different factors, including the number of hospitals in a system, the number of beds, and the number of primary care physicians, among others.

The study examined data from 676 healthcare systems, including 3,839 hospitals and affiliated outpatient sites.

“Those that were overusing health care had more beds, had fewer primary care physicians, had more physician practice groups, were more likely to be investor owned, and were less likely to include a major teaching hospital,” the study found.

Systems with a higher number of hospitals and more beds also demonstrated more overuse, the authors wrote.

While the study doesn’t cover every healthcare service, the authors noted, “We expect that health systems that are overusing these indicator procedures are likely to be globally overusing health services.”

Overuse in the healthcare system represents a genuine danger to patients, the authors explained. It brings the potential for greater health risks and psychological harm. In addition, overuse can be very costly for patients.

Systems with a higher number of primary care physicians were less likely to show a tendency toward overuse.

Health systems with a teaching hospital were less likely to demonstrate overuse, the study found.

Integrated health care delivery systems, such as Kaiser Permanente, were lower in overuse, the study found. The authors also pointed to health systems “known for their attention to high-value care,” including the University of Utah Hospitals and Intermountain Health Care.

Large public and safety net hospitals, such as the New York City Health and Hospitals Corporation and Cook County Health and Hospital System, were also less likely to engage in overuse, the study found.

On the other side of the coin, the study found a “strong relationship” between overuse and investor ownership of a health system.

The analysis examined 20 investor-owned systems and 12 were in the categories on the index showing more overuse. Investor-owned systems “were markedly overrepresented in the highest overuse categories,” the authors wrote.

The study also found that health systems in highly competitive local markets were more likely to be demonstrating overuse of healthcare.

Some geographic areas were more prone to overuse, including Los Angeles, Seattle, and Fort Lauderdale, Fla.

The study didn’t find any substantial evidence of overuse with health systems owned by insurance plans. The analysis didn’t show any greater tendency toward overuse with an accountable care organization’s presence in a health system.

The authors said the Overuse Index could be a valuable tool to help healthcare systems reduce excessive use of services.

The analysis was conducted in the spring and summer of 2021. Researchers examined Medicare beneficiary claims from July 2015 through December 2018.

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