In Delivering Care, More Isn't Always Better, Experts Say

The misuse and overuse runs from simple antibiotics to sophisticated surgeries, Rosof said. More than $58 billion is spent on inappropriate drugs, such as antibiotics for upper respiratory infections that do not respond to medication, according to the institute report. About $21 billion is spent treating non-urgent cases in the emergency department, where physicians rely more on duplicative and costly tests because they are unfamiliar with their patients' histories.

The largest potential area for savings -- up to $600 billion a year -- is the great "unexplained" variation in hospital procedures such as the number of Caesarean sections and coronary bypass surgeries performed. Vaginal delivery is far safer than a C-section, and prescription medicines can stabilize many heart patients without dangerous surgical complications, Rosof said. Less invasive and risky alternatives are also less expensive.

"We will eliminate a lot of harm that comes from the overuse and inappropriate use and misuse of medical interventions," he said. "This is not about rationing. This is about practicing evidence-based medicine."

In theory, Joseph Antos, a health policy scholar at the American Enterprise Institute, agrees. One classic example, he said, is the widespread use of full-body scans "by middle-class people who are probably a little neurotic."

"If they want to spend their money on that, that's fine. If they want to spend our money on that, we ought to think about it," he said. "The problem is, there are very few examples of things like full-body scans where it is a no-brainer. When you get down to the specific individual cases, it's very difficult."

In a world of finite resources, it is logical to worry about rationing, said Mark V. Pauly, a professor of health-care management at the Wharton School of Business in Philadelphia. Making greater use of advanced practice nurses is one way to trim costs and maintain high quality, he said. But he suspects there are few instances of such "low-hanging fruit."

Many others express confidence that better data on what works and greater use of electronic medical records will help physicians deliver high-value care. But the shift will also require changes in payment incentives, malpractice laws and, ultimately, cultural attitudes.

In today's system, doctors face increasing pressure to perform expensive tests and procedures they know may not be necessary, or even advisable, said Arthur Kellerman, an associate dean at Emory School of Medicine in Atlanta and a physician at that city's Grady Memorial Hospital. Patients routinely arrive in the hospital's emergency room complaining of a headache and asking for a CT scan. Though the costly scan can help detect tumors and aneurysms, Kellerman counsels against it, explaining the risk of radiation exposure.

"We can always revisit it down the road if the problem persists," he tells the patient. Kellerman has just rationed care. But, he maintains, it is the right kind of rationing, based on known benefits and risks. And reducing traffic in the ER helps free up beds, machines and doctors to treat the true emergencies.

As he put it: "In the United States today, we give you all the care you can afford, whether or not you need it, as opposed to all the care you need, whether or not you can afford it."

Research editor Alice Crites contributed to this report.