Overutilization (also unnecessary health care or unnecessary care) refers to medical services that are provided with a higher volume or cost than is appropriate. In the United States, where health care costs are the highest as a percentage of GDP, overutilization is the predominant factor in its expense. Factors that drive overutilization include paying health care providers more to do more (fee-for-service) and covering patients' costs by a third-party (public or private insurance) payer. These factors leave both doctors and patients with no incentive to restrain health care prices or use.
Similarly, overtreatments are unnecessary medical interventions (therapies). They could be medical services for a condition that causes no symptoms and will go away on its own, or intensive treatments for a condition that could be remedied with very limited treatment. Overdiagnosis, when patients are given a diagnosis that will cause no symptoms or harm, can lead to overtreatment.
When care is overused, patients are put at risk of complications unnecessarily, while health care providers (such as doctors and hospitals) receive revenue from the over-treatment when coupled to a fee-for-service (FFS) payment model; FFS is a large incentive for overutilization. In the United States, the country which spends the most on health care per person globally, overutilization is the most important contributor to the high cost. The New York Times reports that a "chronic overuse of medical care" exists in the United States. Unnecessary care, defined as services which show no demonstratable benefit to paitents, may represent 30% of U.S. medical care.
Most physicians accept that laboratory tests are overused, but "it remains difficult to persuade them to consider the possibility that they, too, might be overutilizing laboratory tests".
Defining inappropriate services 
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Cost, quality and policy implications 
In the United States, overutilization is a costly expense that lowers the quality of health care.
Between $.30 and $.40 of every dollar spent on health care is spent on the costs of poor quality. This extraordinary number represents slightly more than a half-trillion dollars a year [in 2005]. A vast amount of money is wasted on overuse, underuse, misuse, duplication, system failures, unnecessary repetition, poor communication, and inefficiency.
Fisher et al. demonstrated that "there is no apparent regional health benefit for Medicare recipients from doing more, whether 'more' is expressed as hospitalizations, surgical procedures, or consultations within the hospital". Up to 30% of Medicare spending may be cut without harming patients. Overuse of medical care in the United States is costing Americans billions of dollars every year. Gibson and Singh have documented harm to patients from overuse of surgeries and other treatments. .
Contributing factors and examples 
Factors that contribute to overutilization include "self-referral, patient wishes, inappropriate financially motivated factors, health system factors, industry, media, lack of awareness" and defensive medicine.
Third-party payers and fee-for-service 
When patients have their expenses covered by public or private insurance, and doctors are paid under a fee-for-service (FFS) model, neither have an incentive to consider the cost of treatment, a combination which contributes to waste.
Atul Gawande investigated U.S. Medicare FFS reimbursements in the town of McAllen, Texas for a 2009 article in the New Yorker. McAllen, in 2006, was the second most expensive Medicare market, behind Miami. McAllen's costs, per beneficiary, were almost twice the national average. In 1992, however, McAllen was almost exactly in line with the Medicare spending average. After looking at other potential explanations such as relatively poorer health or medical malpractice, Gawande concluded that the town was a chief example of the overuse of medical services. Gawande concluded that it appeared a business culture (where physicans view their practices as a revenue stream) had established itself there, in contrast to a culture of low-cost high-quality medicine at the Mayo Clinic and in the Grand Junction, Colorado market. Gawande advised that
As America struggles to extend health-care coverage while curbing health-care costs, we face a decision that is more important than whether we have a public-insurance option, more important than whether we will have a single-payer system in the long run or a mixture of public and private insurance, as we do now. The decision is whether we are going to reward the leaders who are trying to build a new generation of Mayos and Grand Junctions. If we don’t, McAllen won’t be an outlier. It will be our future.
Overutilization of diagnostic imaging, such as X-rays and CT scans, is defined as any application that is unlikely to improve patient care. Respected organizations—such as the American College of Radiology (ACR), Royal College of Radiology (RCR) and the World Health Organization (WHO)—have developed "appropriateness criteria".
Physician self-referral 
One type of overutilization can be physician self-referral. Multiple studies have replicated the finding that when non-radiologists have an ownership interest in the fees generated by radiology equipment—and can self-refer—their utilization of imaging is unnecessarily higher. The majority of U.S. growth in imaging utilization (the fastest growing physician service) comes from self-referring non-radiologists. In 2004, this overutilization was estimated to contribute to $16 billion of annual U.S. health care costs.
The 2010 U.S. health care reform, the Patient Protection and Affordable Care Act, did not contain serious strategies to reduce overutilization; "the public has made it clear that it does not want to be told what medical care it can and cannot have". Uwe Reinhardt, a health economist at Princeton, said "the minute you attack overutilization you will be called a Nazi before the day is out".
- Hospitalizations, including admissions for those with chronic conditions who could be treated as outpatients
- Surgeries in Medicare patients in their last year of life, regions with high levels had higher death rates
- Antibiotic use (an overmedication)
- Effects of direct to consumer marketing
- Opiate prescriptions
- Blood transfusions in the U.S.
- An estimated one in eight coronary stents (used in $20,000 procedures) with non-acute indications (U.S.)
- Heart bypass surgeries at Redding Medical Center which resulted in a FBI raid
- 2008 Medicare rates of double scanning with chest CTs
- Screening patients with advanced cancer for other cancers
- Annual cervical cancer screening in women with medical histories of normal pap smear and HPV test results
Medical malpractice laws and defensive medicine 
Physicians are incentivized to order clinically unnecessary, or of little potential value, tests in order to protect themselves from prosecution. While defensive medicine is a favored explanation for high medical costs by physicians, it was estimated to only contribute to 2.4% of the total $2.3 trillion of U.S. health care spending in 2008.
Cost sharing 
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See also 
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- Ezekiel J. Emanuel & Victor R. Fuchs. "Health Care Overutilization in the United States—Reply". JAMA : The Journal of the American Medical Association 300 (19): 2251. doi:10.1001/jama.2008.605.
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- Jamie A. Weydert, Newell D. Nobbs, Ronald Feld & John D. Kemp (September 2005). "A simple, focused, computerized query to detect overutilization of laboratory tests". Archives of Pathology & Laboratory Medicine 129 (9): 1141–1143. doi:10.1043/1543-2165(2005)129[1141:ASFCQT]2.0.CO;2. PMID 16119987.
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- Gibson; Singh, Rosemary (2010). The Treatment Trap: How the Overuse of Medical Care is Wrecking Your Health. Chicago: Ivan R. Dee. p. 30. ISBN 9781566638425.
- Gibson; Singh, Rosemary (2010). The Treatment Trap: How the Overuse of Medical Care is Wrecking Your Health. Chicago: Ivan R. Dee. p. 63-83. ISBN 9781566638425.
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Further reading 
- Shannon Brownlee (2007). Overtreated: Why too much medicine is making us sicker and poorer. London: Bloomsbury. ISBN 1-58234-580-5.
- Hendee WR, Becker GJ, Borgstede JP, et al. (October 2010). "Addressing overutilization in medical imaging". Radiology 257 (1): 240–5. doi:10.1148/radiol.10100063. PMID 20736333.
- R. E. Malone (October 1998). "Whither the almshouse? Overutilization and the role of the emergency department". Journal of Health Politics, Policy and Law 23 (5): 795–832. doi:10.1215/03616878-23-5-795. PMID 9803363.
- Sana M. Al-Khatib, Anne Hellkamp, Jeptha Curtis, Daniel Mark, Eric Peterson, Gillian D. Sanders, Paul A. Heidenreich, Adrian F. Hernandez, Lesley H. Curtis & Stephen Hammill (January 2011). "Non-evidence-based ICD implantations in the United States". JAMA : The Journal of the American Medical Association 305 (1): 43–49. doi:10.1001/jama.2010.1915. PMID 21205965.
- David B. Larson, Lara W. Johnson, Beverly M. Schnell, Shelia R. Salisbury & Howard P. Forman (January 2011). "National trends in CT use in the emergency department: 1995–2007". Radiology 258 (1): 164–173. doi:10.1148/radiol.10100640. PMID 21115875. – a story on the study
- Disease Creep: How we're fooled into using more medicine than we need by medical investigative journalist Jeanne Lenzer