Intended for healthcare professionals

Feature Feature

The human cost of overuse

BMJ 2014; 348 doi: (Published 06 May 2014) Cite this as: BMJ 2014;348:g2975
  1. Rosemary Gibson, senior advisor, The Hastings Center, 21 Malcolm Gordon Road, Garrison, New York 10524, USA
  1. gibsonr{at}

Rosemary Gibson looks to the small town of China, Maine, to see the impact that escalating health costs have on a community

State and local governments in the United States are making financial trade-offs as healthcare spending, fueled by overuse, consumes an enormous and growing share of their budgets.

In Massachusetts, state government spending on education and other essential services declined during the past 10 years while healthcare spending jumped 59%, according to Donald Berwick, president emeritus of the Institute for Healthcare Improvement.

Fifteen thousand pairs of used shoes

Similar trends can be found in a suburban New York town where health insurance premiums for the school district jumped 27% in one year. This increase was a factor in the decision to close two schools, including this author’s grammar school. Teachers were laid off. The community held fundraisers to save afterschool music and sports programs. For one of the fundraisers, students collected 15 000 pairs of used shoes, 7 tons of them, to raise $6000 (£3500; €4300).

In an economy with lackluster growth, healthcare employment may increase as spending jumps, but only at the expense of jobs in other sectors such as education—a “robbing Peter to pay Paul” scenario.

The situation in China, Maine

Communities around the country are making trade-offs as healthcare consumes a larger share of their resources. Dan L’Heureux is the full time town manager of China, Maine and understands the trade-offs small …

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