Review article
High value, cost-conscious care: An international imperative

https://doi.org/10.1016/j.ejim.2012.03.006Get rights and content

Abstract

Health care costs in the United States are the highest in the world, and are continuing to rise at a level that is unsustainable. However, although this problem is more acute in the United States than elsewhere in the world, it is a challenge for all nations to control the costs of health care. The high cost of health care in the U.S. is not accompanied by a higher quality of care, but rather is related in large measure to health system “waste” that does not benefit patients but adds to cost. Representing approximately 30% of dollars spent on health care, this waste includes a significant amount of money spent on overuse and misuse of diagnostic testing, including screening tests. The American College of Physicians, the largest specialty society for physicians in the U.S., representing internal medicine and all of its subspecialties, has embarked upon a High Value, Cost-Conscious Care initiative, aimed at identifying areas of overuse and misuse of care, and leading to development of guidelines, educational materials, and other resources targeted to health care providers, trainees, and the general public. It is incumbent upon physicians, non-physician health care professionals, patients, and other health care stakeholders to address the issue of reducing care that is not appropriate, both to improve the overall quality of care and to reduce the associated unsustainable financial burden to society.

Section snippets

Learning points

  • Health care costs in the United States, which already represent nearly 18% of GDP, are continuing to rise at an unsustainable rate.

  • Approximately 30% of health care costs in the U.S. are thought to be “wasted,” i.e. adding to costs without benefiting patients.

  • The number of diagnostic tests per patient, including imaging studies, has risen by approximately 85% over the past decade, and the overuse of these studies must be addressed in order to provide optimal care and control costs.

  • It is an

Conflict of interest statement

Dr. Hood is President of the American College of Physicians (2011–2012). She has no other conflicts of interest.

Dr. Weinberger is an employee of the American College of Physicians. He has no other conflicts of interest.

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