Unnecessary health care costs money and can even harm patients. A new study in the Journal of the American Medical Association Internal Medicine suggests that where you see your doctor affects how likely you are to receive an unnecessary test or referral to a specialist.
Using data from more than 31,000 doctor visits in which patients complained of back pain, headaches or upper respiratory tract infections, the study suggests that doctors on hospital campuses were more likely to order unnecessary tests or referrals than doctors in community practices.
While the rate of antibiotic prescription was similar in both settings, the study found that patients with the same symptoms who saw doctors at hospital campuses were more likely to be referred for MRI or CT scans and X-rays than those who went to doctors in community-based practices. They were also more likely to be sent for evaluation by a specialist.
"One of the most important problems of our time is rising health care costs," said the study's lead author Dr. John Mafi, an assistant professor at UCLA's David Geffen School of Medicine. Unnecessary testing and referrals add to health care spending in the U.S., he said — which in 2015 totaled more than $3 trillion.
There were several factors might play a role in causing the difference, Mafi said. The study found that doctors who did not have a continuous relationship with the patient beforehand were more likely to order tests.
"It makes sense," said Mafi, who is himself based on UCLA's hospital campus. "If you don’t know the patient as well, you’re going to be a little more cautious and a little more trigger-happy to order that test."
Another possible factor, he said, is that doctors on hospital campuses often have ready access to specialized equipment like MRI scanners, and so are more likely to use it — even though several studies have suggested it is unnecessary in most cases of lower back pain.
"Doing those tests on the whole provides no benefit compared to not getting it, and also they can actually cause harm through radiation exposure, through finding something that is actually meaningless but causes a lot of anxiety," said Mafi.
While Mafi said it was not possible to say that all of the testing ordered by doctors in the study was unnecessary or of little benefit, "We can say very confidently that many if not most of them were low value." He said patients can do their part to reduce unnecessary tests by asking questions: "Doctor, do I really need this test? What are the benefits that I could expect? What are the harms I could expect?"
John Romley, associate professor at USC's Price School of Public Policy, said this kind of study was important because "We need to know where the really problematic places within our health care system in terms of delivering low value care [are]. We need the diagnosis in order to know what to do."
"We have a real problem with health care spending in this country," said Romley. It is likely that health care that was of little or no benefit added to the overall cost of health care, he said, because it "leads to both higher commercial insurance premiums and greater Medicare spending, and thus burden on taxpayers."