Covid-19 is causing researchers to look closely at a problem that has challenged the medical community for decades: the overtreatment and unnecessary treatment of patients. There is the fact that the pandemic caused major health setbacks for non-covid patients who have had to make decisions to avoid or postpone tests and treatments for a variety of illnesses. Alternatively there are cases in which no harm was done by delays or cancellations, and medical experts can reevaluate whether those procedures are truly necessary.
Overtreatment causes unnecessary suffering and billions of dollars in unnecessary health care costs, as evidenced in past studies. According to researcher Allison Oakes, this is the first time there has been a database of this size to compare patients who received a particular test or treatment with those who did not.
Oakes was a principal author of an October paper in Health Affairs by the Research Consortium for Health Care Value Assessment. The paper noted that covid provided an important new measurement — examining outcomes for patients who received treatment before hospitals canceled care because of covid and those who had their care canceled. Treatment that was done less often included colonoscopies done on patients older than age 85; hemoglobin blood work for Type 2 diabetes patients; semi-elective surgeries, such as knee arthroscopy for articular cartilage surgery; and yearly dental X-rays. All were done less often because of covid, Oakes said.
“There are two sides of the pie: low-value care and care that people get in trouble if they don’t get,” said Oakes, who expects researchers to take advantage of all the data provided from covid on “both types of care.”
One recent study examined Veterans Affairs patients who cancelled elective surgeries because of covid. The study found they were no more likely to visit hospital emergency departments than patients who had undergone those surgeries in 2018.
Dr. Heather Lyu of Brigham and Women’s Hospital and Harvard Medical School said testing and care was reduced or cancelled by patients’ fears because of the fear of contracting covid in a medical setting and because medical facilities and staffers were fighting just to keep up with covid cases.
“There are some procedures, tests, and exams that cannot be delayed in any situation,” Lyu said in an email. As an example, she highlighted the screening, surveillance and treatment of cancer patients.
However, she said other tests and treatments can be delayed or canceled without negative effects. Lyu oversaw a 2017 survey of 2,000 physicians, with half the doctors saying the percentage of unnecessary medical care was higher than 20.6% and half saying it was lower.