How to Reduce Medical Overuse

In a recent JAMA Internal Medicine article, Allison Lipitz-Snyderman and Peter B. Bach identify three types of overuse of healthcare services:

1. Benefits small relative to risks
2. Benefits small relative to costs
3. Service unwanted

 The first two require especially difficult value-laden choices and tradeoffs.  What dollar cost per QALY is too much?  When are the benefits too low?  

But the third type of overuse seems far less controversial.  If the patient does not even want the healthcare service, then it almost always wrong to provide it.  While hardly a complete solution, I have recently demonstrated how the law is starting to play a greater role in mitigating unwanted treatment.