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      From an Ethics of Rationing to an Ethics of Waste Avoidance

      1
      New England Journal of Medicine
      Massachusetts Medical Society

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          Eliminating waste in US health care.

          The need is urgent to bring US health care costs into a sustainable range for both public and private payers. Commonly, programs to contain costs use cuts, such as reductions in payment levels, benefit structures, and eligibility. A less harmful strategy would reduce waste, not value-added care. The opportunity is immense. In just 6 categories of waste--overtreatment, failures of care coordination, failures in execution of care processes, administrative complexity, pricing failures, and fraud and abuse--the sum of the lowest available estimates exceeds 20% of total health care expenditures. The actual total may be far greater. The savings potentially achievable from systematic, comprehensive, and cooperative pursuit of even a fractional reduction in waste are far higher than from more direct and blunter cuts in care and coverage. The potential economic dislocations, however, are severe and require mitigation through careful transition strategies.
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            Medicine's ethical responsibility for health care reform--the Top Five list.

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              The problem with futility.

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                Author and article information

                Journal
                New England Journal of Medicine
                N Engl J Med
                Massachusetts Medical Society
                0028-4793
                1533-4406
                May 24 2012
                May 24 2012
                : 366
                : 21
                : 1949-1951
                Affiliations
                [1 ]From the Institute for the Medical Humanities, University of Texas Medical Branch, Galveston.
                Article
                10.1056/NEJMp1203365
                22551106
                87ef4e18-bb30-45e1-af75-58625aa731a7
                © 2012
                History

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