We benefited from reading your article about unnecessary emergency room visits, which is the fourth largest waste of medical costs. What are the first three wastes?

— Tom, Medford

 

In various research papers and reports covering several years, the New England Healthcare Institute lists emergency room overuse as either the third or fourth top category of waste in the United States health care system.

The institute defines waste as health care spending that can be eliminated without reducing the quality of care. It notes America spends more than any other country on health care per capita, but doesn't get the best health outcomes.

Topping the list, the institute says unexplained variations in the intensity of medical and surgical services are the biggest source of waste. For example, some geographic areas have much higher rates of artery procedures, aggressive end-of-life care, prostrate removal and back surgery that may not be necessary. Reducing unnecessary procedures could save $600 billion, according to research the institute published in 2008.

Adverse treatment events are second on the list and include medical errors such as operating on the wrong leg, hospital-acquired infections and predictable side effects and unexpected bad reactions to drugs. Adverse treatment events lead to $52.2 billion in wasteful spending.

In research that lists emergency room overuse third, the institute says eliminating such misuse could save $21.4 billion.

Underuse of appropriate medication is the fourth category of waste. As examples, switching people on costly hypertension medication to low-cost generics could save $3 billion annually, while making sure kids have medicine to control their asthma could save $2.5 billion by cutting emergency room visits and hospitalizations.

Conversely, overuse of antibiotics — especially for viral infections such as colds that are not susceptible to antibiotics — wastes $1.1 billion and is the fifth largest category of waste, according to the institute. 

In a 2010 paper that bumps emergency room overuse from the third to the fourth spot for waste, the institute adds in another category — patient medication adherence — to create six major sources of waste.

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