unnecessary health care unnecessary health care unnecessary health care (overutilization, overuse, or overtreatment) is health care provided with a higher volume or cost than is appropriate. in the united states, where health care costs are the highest as a percentage of gdp, overuse was the predominant factor in its expense, accounting for about a third of its health care spending ($750 billion out of $2.6 trillion) in 2012. factors that drive overuse include paying health professionals more to do more (fee-for-service), defensive medicine to protect against litigiousness, and insulation from price sensitivity in instances where the consumer is not the payer—the patient receives goods and services but insurance pays for them (whether public insurance, private, or both). such factors leave many actors in the system (doctors, patients, pharmaceutical companies, device manufacturers) with inadequate incentive to restrain health care prices or overuse. this drives payers, such as national health insurance systems or the u.s. centers for medicare and medicaid services, to focus on medical necessity as a condition for payment. however, the threshold between necessity and lack thereof can often be subjective. overtreatment, in the strict sense, may refer to unnecessary medical interventions, including treatment of a self-limited condition (overdiagnosis) or to extensive treatment for a condition that requires only limited treatment. it is economically linked with overmedicalization. definition a forerunner of the term was what jack wennberg called unwarranted variation, different rates of treatments based upon where people lived, not clinical rationale. he had discovered that in studies that began in 1967 and were published in the 1970s and the 1980s: "the basic premise – that medicine was driven by science and by physicians capable of making clinical decisions based on well-established fact and theory – was simply incompatible with the data we saw. it was immediately apparent that suppliers were more important in driving demand than had been previously realized." in 2008, us bioethicist ezekiel j. emanuel and health economist victor r. fuchs defined unnecessary health care as "overutilization", health care provided with a higher volume or cost than is appropriate. recently, economists have sought to understand unnecessary health care in terms of misconsumption rather than overconsumption. in 2009 two us physicians wrote in an editorial, that unnecessary care was "defined as services which show no demonstrable benefit to patients" and might represent 30% of u.s. medical care. they referred to a 2003 study on regional variations in medicare spending, which found, "medicare enrollees in higher-spending regions receive more care than those in lower-spending regions, but do not have better health outcomes or satisfaction with care." in january 2012, the american college of physicians ethics, professionalism, and human rights committee suggested that overtreatment can also be understood in contrast to 'parsimonious care', defined as "care that utilizes the most efficient means to effectively diagnose a condition and treat a patient." in april 2012, berwick, from the institute for healthcare improvement, and andrew hackbarth from the rand corporation defined overtreatment as "subjecting patients to care that, according to sound science and the patients' own preferences, cannot possibly help them—care rooted in outmoded habits, supply-driven behaviors, and ignoring science." they wrote that trying to do something (treatment or testing) for all patients who might need it inevitably entails doing that same thing for some patients who might not need it." in uncertain situations, "some non-beneficial care was the necessary byproduct of optimal clinical decision making." in october 2015, two pediatricians said that considering "overtreatment as an ethical violation" could help see the conflicting incentives of health care workers for treatment or nontreatment. low-value health care, for the most part, is administration of tests or treatment, which though useful initially, offer little value if given repeatedly as a part of routine care. cost in the us, the country which spends the most on health care per person globally, patients have fewer doctor visits and fewer days in hospitals than people in other countries do, but prices are high, there is more use of some procedures and new drugs than elsewhere, and doctor salaries are double the levels in other countries. the new york times reported "no one knows for sure" how much unnecessary care exists in the united states. overuse of medical care is no longer a large fraction of total health care spending, which was $3.3 trillion in 2016. researchers in 2014 analyzed many services listed as low value by choosing wisely and other sources. they looked at spending in 2008–2009 and found that these services represented 0.6% or 2.7% of medicare costs and there was no significant pattern of particular types of physicians ordering these low value services. the institute of medicine in 2010 gave two estimates of "unnecessary services," using different methodologies: 0.2% or 1% to 5% of health spending, which was us$2.6 trillion. the institute of medicine quoted that 2010 report in a 2012 report to support an estimate of 8% ($210 billion) in unnecessary services, without explaining the discrepancy. this iom 2012 report also said there were $555 billion in other wasted spending, which have an "unknown overlap" with each other and the $210 billion. the united states national academy of sciences estimated in 2005, without giving its methods or sources, that "between $.30 and $.40 of every dollar spent on health care is spent on the costs of poor quality," amounting to" slightly more than a half-trillion dollars a year... wasted on overuse, underuse, misuse, duplication, system failures, unnecessary repetition, poor communication, and inefficiency. in 2003 fisher et al. found that there was "no apparent regional health benefit for medicare recipients from doing more, whether 'more' is expressed as hospitalizations, surgical procedures, or consultations within the hospital." up to 30% of medicare spending could be cut in 2003 without harming patients. when care is overused, patients are put at risk of complications unnecessarily, with documented harm to patients from overuse of surgeries and other treatments. causes physicians' decisions are the proximate cause of unnecessary care, though the potential incentives and penalties they face can influence their choices. third-party payers and fee-for-service