In a series of papers and comments published in The Lancet, Vikas Saini, and his colleagues provide a framework for thinking about how to address the inequities in the provision of affordable healthcare to people. The analysis addresses inequity in both high-income countries (HICs) as well as low and middle-income countries (LMICs). Their hope is to spark "serious discussions about what kind of health system we want for the 21st century as part of our commitment to universal health coverage." They believe that overuse (the provision of medical services that are more likely to cause harm than good and underuse (the failure to use effective and affordable medical interventions) of medical services takes away from "right care."
"In its simplest definition it (right care) is care that weighs up benefits and harms, is patient-centred (taking individual circumstances, values, and wishes into account), and is informed by evidence, including cost-effectiveness."In the paper that focuses on evidence for overuse of medical services, the authors Brownlee and her colleagues make a distinction between services that are clearly and universally beneficial when used on the right patient and services that are definitely inappropriate. However, they point out, most services lie within a "grey zone" where the risk-benefit profile varies widely depending on the patient (e.g. antidepressants for adolescents). Moreover, decision making in providing these services is often based on physician assumptions and biases rather than being grounded in client preferences. They report on overuse measured in two ways - directly through registries and medical records and indirectly, through geographical variation in service utilization that is not linked to the populations serviced.















Comment: See also:
A closer look at the myth of cancer screening tests
When It's Time For a Health Check-up, Avoiding Your Doctor Can Save Your Life