Summary of Overkill by Atul Gawande


The article talks about U.S. healthcare industry overdoing tests, diagnosis, and other procedures that cost a lot of money but don’t improve a patient’s condition. Researchers looked at 26 different treatments including EEG (for a small headache), CT Scan, MRI Scan (for low back pain) that were receommended and found that 25% — 40% of patients received one of these treatments.

In 2010, Institute of Medical Health estimated that 30% of total expenditure (~$750 Billion) was wasted on treatments that were not required. Higher prices, administrative expenses, and fraud accounted for half of this waste.

McAllen Texas had one of the highest per-capita medical expenditure of any community in the U.S. Doctors were recommending unnecessary tests that drove up the costs. In a federal investigation, they found doctors were recommending a lot of these services for kick backs, the ambulance company charged for 621 trips that never happened, labs falsified thousands of tests that never happened.

Osio is a doctor with an independent practice where he sees Medicare and Medicaid patients for $60 per visit. He saves them and everyone else money by providing them necessary care rather than unnecessary care. He knows the history of the patient, so he doesn’t recommend all the unnecessary tests. WellMed is a hospital chain that is trying to reduce the costs by reducing expenses on unnecessary care and rewarding doctors based on costs saved and providing long term necessary care to patients.

Companies are tying up with hospitals and clinics to save costs on employee healthcare. They have free treatments with partner hospitals and high deductibles and co-insurance payments on plans for outside hospitals. The only condition is that the hospital will conduct it’s own examination. Doctors prescribe tests and procedures for things that d0 not require surgery and other expensive types of treatments which substantially adds to a company’s employee healthcare cost but they pay a negotiated rate for the partner hospitals. e.g. employee at Walmart was suggested a surgery for spine at a hospital but it was too costly so he went to Walmart’s partner hospital. They found that he didn’t need a surgery and suggested other treatments (which ended up being better than the surgery.)

A woman was told that she needs to get a surgery for a micro-carcinoma(small cancer). The cancer was really small and the harm/risks of a successful surgery outweighed the other procedures. The surgery wasn’t required because cancer wasn’t life threatening and wasn’t expected to grow to become a terminal illness.

As we are improving technology, we are finding more problems but most of them are not life threatening at all. They are so small and insignificant that they will not affect normal life and won’t become dangerous in average lifespan of a person. Doctors are constantly doing procedures and treatments for these things but that doesn’t drop the death rate. Same goes in the car industry. Mechanics diagnose your car and slowly tell you to fix things that don’t require fixing but it doesn’t increase the life of your car.

If insurance companies deny coverage for procedures, there will be outrage. This needs to be tackled in a way where we are replacing unnecessary care with necessary long term care.

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