Health Services Utilization Study

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Up to One-Third of Selected Medical Procedures May Be Performed for Inappropriate Reasons

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SOURCE: Multiple RAND studies, 1983-1998.

More care isn't necessarily better care

In a series of studies stretching from the mid-1980s to the late 1990s, RAND Health researchers examined the appropriateness of the use of various medical and surgical procedures. Using a rigorous methodology, the studies first rated all of the indications for performing a given procedure, then used those ratings to determine whether the procedures were performed for "necessary," "appropriate," "inappropriate," or "equivocal" reasons. Generally, a procedure was considered to be "appropriate" if the patient's expected health benefits exceeded the expected health risks by a substantial margin.

Overall, the RAND studies found that significant proportions of procedures are performed for inappropriate reasons. The rates of inappropriate use range from a low of 2 percent for coronary artery bypass graft surgery (CABG) and cataract removal to a high of 32 percent for carotid endarterectomy. Rates of equivocal use also vary dramatically. On average, one-third or more of all procedures performed in the United States appear to be of questionable benefit.

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