Reducing Overuse

Overuse has become a major issue of healthcare quality, safety,and sustainability around the world. In this Element, the authors discussconcepts, terminology, and the history of concerns. They show howinterventions to address overuse target multiple drivers. They highlightnot only successes and promising approaches but also challenges ingenerating and using evidence about overuse. They emphasise thatdifferent stakeholder perceptions of value must be recognised.System-level efforts to restrict access to services have created tensionsbetween stakeholder groups and stimulated politicised debates aboutrationing. They argue for clear articulation of priorities, problemdefinition, mechanisms for interventions, and areas of uncertainty.Policy-makers should prioritise transparency, be alert to inequalities asthey seek to reduce overuse, and consider how to balance controllinguse with enabling clinicians to respond to individual circumstances. Thecomplexity of the drivers and possible solutions to overuse require theuse of multiple research methods, including social science studies.