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Eliminating Waste in U.S. Health Care

Donald M. Berwick, MD, MPP, and Andrew D. Hackbarth, MPhil, have authored an essay posted on Tuesday by JAMA, titled, “Eliminating Waste in US Health Care.”  The abstract of the essay states, “The need is urgent to bring U.S. health care costs into a sustainable range for both public and private payers.  Commonly, programs to contain costs use cuts, such as reductions in payment levels, benefit structures, and eligibility. A less harmful strategy would reduce waste, not value-added care.  The opportunity is immense.

In just 6 categories of waste—overtreatment, failures of care coordination, failures in execution of care processes, administrative complexity, pricing failures, and fraud and abuse—the sum of the lowest available estimates exceeds 20% of total health care expenditures. The actual total may be far greater. The savings potentially achievable from systematic, comprehensive, and cooperative pursuit of even a fractional reduction in waste are far higher than from more direct and blunter cuts in care and coverage.  The potential economic dislocations, however, are severe and require mitigation through careful transition strategies.”

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