The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary

BOX A-1

Excess Cost Domain Estimates: Lower bound totals from workshop discussions*

UNNECESSARY SERVICES	Total excess = $210 B*
Overuse: services beyond evidence-established levels Discretionary use beyond benchmarks Defensive medicine Unnecessary choice of higher cost services
INEFFICIENTLY DELIVERED SERVICES	Total excess = $130 B*
Mistakes—medical errors, preventable complications Care fragmentation Unnecessary use of higher cost providers Operational inefficiencies at care delivery sites Physician offices Hospitals
EXCESS ADMINISTRATIVE COSTS	Total excess = $190 B*
Insurance-related administrative costs beyond benchmarks Insurers Physician offices Hospitals Other providers Insurer administrative inefficiencies Care documentation requirement inefficiencies
PRICES THAT ARE TOO HIGH	Total excess = $105 B*
Service prices beyond competitive benchmarks Physician services Specialists Generalists Hospital services Product prices beyond competitive benchmarks Pharmaceuticals Medical devices Durable medical equipment
MISSED PREVENTION OPPORTUNITIES	Total excess = $55 B*
Primary prevention Secondary prevention Tertiary prevention
FRAUD	Total excess = $75 B*
All sources—payer, clinician, patient fraud

*Lower bound totals of various estimates, adjusted to 2009 total expenditure level.