Use and Costs of Nonrecommended Tests During Routine Preventive Health Exams

Even when evidence is to the contrary, many patients and physicians appear to believe that more interventions are always better and a necessary part of a preventive health exam (PHE). This study looks at how often nonrecommended diagnostic tests and procedures in asymptomatic individuals are ordered during routine PHEs and the associated costs. The authors conducted a cross-sectional survey of office-based interventions during outpatient visits for nonpregnant adults aged 21 and older with data obtained from National Ambulatory Medical Care Survey (NAMCS), collected from 1997 to 2002 and analyzed in 2005. Laboratory tests and procedures not recommended, according to the United States Preventive Services Task Force (USPSTF) guidelines included urinalysis, electrocardiograms and X-rays.

Key Findings:

  • The frequency of ordering any of the three diagnostic interventions ranged from 5 percent to 37 percent, and at least one of the interventions was ordered 43 percent of the time.
  • Annual direct costs for the three interventions not recommended by the USPSTF range from $47 million to $194 million.
  • Medicaid patients had fewer recommended tests compared to those with private insurance.

A potential limitation of the study is the possibility that some of the interventions performed during the PHE visits were indicated for these patients. The authors conclude that less use of unwarranted interventions will likely eliminate waste and improve the overall quality of health care in the United States.