Addressing overuse and underuse around the world

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Saini, V., Brownlee, S., Elshaug, A. G., Glasziou, P., & Heath, I. (2017, in press). Addressing overuse and underuse around the world. The Lancet.

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Copyright © 2017 Elsevier Ltd




The benefits of modern medical care have advanced the health of populations around the world, but with better health has come rising health-care spending. Not surprisingly, there is global interest in optimising the delivery of health services, exemplified by the universal health coverage (UHC) and waste in research campaigns.Comparatively neglected is a central paradox that afflicts high-income countries (HICs) and low-income and middle-income countries (LMICs) alike: the failure to deliver needed services alongside the continuing delivery of unnecessary services. The Lancet Series on right care aims to bring these two issues—overuse and underuse—to the centre of global health strategies (panel).

Panel: Key messages in Right Care Series

Overuse and underuse coexist within populations, within systems, and even within patients around the world.

Underuse of proven medical care and overuse of unproven services causes suffering to millions of people around the world. The costs are serious: physical, psychological, and social harms for patients and wasteful misallocation of resources for society.

Because most care falls in a grey zone in which benefits and harms are not clear, attention to preferences of patients is essential. The medical community needs to do what patients want rather than what health professionals know how to do.

Overuse and underuse are symptoms of a health-care system that does not reflect the ethics of medicine. They undermine the capacity of countries to achieve sustainable universal health coverage and to ensure that health care is a human right. Action is possible and necessary.

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