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Viewpoint |

Doing More vs Doing Good Aligning Our Ethical Principles From the Personal to the Societal

Shawn L. Ralston, MA, MD, MS1,2; Alan R. Schroeder, MD3,4
[+] Author Affiliations
1Children’s Hospital at Dartmouth Hitchcock, Lebanon, New Hampshire
2Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
3Santa Clara Valley Medical Center, San Jose, California
4Stanford University College of Medicine, Stanford, California
JAMA Pediatr. 2015;169(12):1085-1086. doi:10.1001/jamapediatrics.2015.2702.
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This Viewpoint explores the topic of overtreatment and its ethical and financial effects on health care and contribution to waste in the health care system.

Health care in the United States is in a state of significant transition. With health care expenditures approaching $3 trillion, substantial attention has been focused on waste in the system. Berwick and Hackbarth2 identified overtreatment as being responsible for at least a quarter of that waste. Thus, there are many new programs designed to increase awareness of the problem of overtreatment and to decrease waste due to the phenomenon, including the Choosing Wisely campaign and shared savings programs from insurers. At the same time, most physicians still work in systems where fee-for-service payments are the norm. In such settings, financial incentives are aligned with doing more on every level—more visits, more tests, more procedures, and more medicines; thus, our system still rewards overtreatment. Berwick and Hackbarth2 defined overtreatment as “subjecting patients to care that, according to sound science and the patients’ own preferences, cannot possibly help them—care rooted in outmoded habits, supply-driven behaviors, and ignoring science.”

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