Reducing wasteful health care spending begs the question, what is waste?

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The U.S. spends more than $2.8 trillion on health care each year, and some estimate that 30% of that price tag may be waste. To promote more effective use of health care resources, a group of national organizations representing medical specialists are working to identify procedures and tests that may be overused. The Choosing Wisely initiative, sponsored by the American Board of Internal Medicine, has over the past few years received more than 300 recommendations from specialists ranging from allergists to thoracic surgeons. These lists are being disseminated to physicians and consumers with the aim of sparking discussion between doctors and patients about appropriate and necessary care.

But will this effort actually help reduce health care spending? Probably not, said Meredith Rosenthal, professor of Health Economics and Policy and associate dean for Diversity, at an August 5, 2014 Hot Topics lecture at Harvard School of Public Health (HSPH). While the recommendations are a good start to a much-needed conversation about what constitutes waste, in their current form they are merely helpful suggestions, she said. In order to affect the bottom line, she added, they would need to be translated into concrete guidelines and billing codes.

Taking that next step would likely be “headache-inducing,” Rosenthal said. “Until we can agree on what services should be avoided, it’s pretty impossible to address [waste].”