Abstract
BackgroundOveruse is a leading contributor to the high cost of health care in the United States. Overuse harms patients and is a definitive waste of resources. The Johns Hopkins Overuse Index (JHOI) is a normalized measure of systemic health care services overuse, generated from claims data, that has been used to describe overuse in Medicare beneficiaries and to understand drivers of overuse. We aimed to adapt the JHOI for application to a commercially insured US population, to examine geographic variation in systemic overuse in this population, and to analyze trends over time to inform whether systemic overuse is an enduring problem.MethodsWe analyzed commercial insurance claims from 18 to 64 year old beneficiaries. We calculated a semiannual JHOI for each of the 375 Metropolitan Statistical Areas and 47 rural regions of the US. We generated maps to examine geographic variation and then analyzed each region’s change in their JHOI quintile from January 2011 to June 2015.ResultsThe JHOI varied markedly across the US. Across the country, rural regions tended to have less systemic overuse than their MSA counterparts (p < 0.01). Regional systemic overuse is positively correlated from one time period to the next (p < 0.001). Between 2011 and 2015, 53.7% (N = 226) of regions remained in the same quintile of the JHOI. Eighty of these regions had a persistently high or persistently low JHOI throughout study duration.ConclusionsThe systemic overuse of health care resources is an enduring, regional problem. Areas identified as having a persistently high rate of systemic overuse merit further investigation to understand drivers and potential points of intervention.
Highlights
Overuse is a leading contributor to the high cost of health care in the United States
The Johns Hopkins Overuse Index (JHOI) in commercial claims Among the 20 indicators that were used to measure systemic overuse with Medicare claims [16, 24], we found that 19 of these 20 procedures met our criteria for application to a younger, commercially insured population
While we have demonstrated that the JHOI is associated with increased health care spending, it is infeasible to directly measure the entire universe of overused procedures and their downstream consequences
Summary
Overuse is a leading contributor to the high cost of health care in the United States. Overuse is often physically and psychologically harmful to patients [5,6,7] and is a definitive misuse of resources. Such wasteful utilization helps to explain why health care spending is inconsistently associated with measures of health care quality [8,9,10]. Analyses of individual procedures have discovered heterogeneous trends in overuse over time. Some interventions, such as renal artery stenting, have declined across years, while others have increased or remained stable [21, 22].
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