Critics of Overtreatment in the U.S. Should Not Look to the U.K. for Answers
As a person who follows the evolution of health care policy from the vantage point of the United States, I found BMJ’s May 12 article on “Choosing Wisely in the UK”  very interesting. The authors ascribe the phenomenon of medical overtreatment in the UK to a culture of “more is better” fostered by such factors as “defensive medicine,” “patient pressures,” “commercial conflicts of interest,” “payment by activity,” and the demands of “pay for performance.”
Many critics of the American health care scene ascribe the problem of irrational overtreatment unsupported by available evidence in the U.S. to precisely the same causes, and argue that the key to rationalizing American medical practice lies in adoption of the UK’s single payer, universal coverage health care system and the UK’s system of civil justice. The fact that a Choosing Wisely program is necessary in the UK, and for most of the same underlying reasons as apply in the U.S., proves that the UK has not found the panacea to achieving rational medical practice and that emulation of the UK methods of health insurance, physician payment, and civil justice will not work as a panacea in the U.S. either.
Reducing wasteful, or even harmful, overtreatment will require a serious realignment of financial, legal, and cultural incentives, but the current UK approaches to paying for medical care and resolving disputes regarding its quality have not demonstrated that they are the most effective model for the U.S. to adopt in its cultivation of practitioners and patients who will choose medical treatment plans more wisely.
1. Malhotra A, Maughan D, Ansell J, et al. Choosing Wisely in the UK: the Academy of Royal Colleges’ initiative to reduce the harms of too much medicine. BMJ 2015;350:h2308.
Marshall B. Kapp, J.D., M.P.H., firstname.lastname@example.org
Competing interests: No competing interests