Why your doctor gets paid for procedures, not outcomes
American healthcare pays by the item - a visit, a test, a procedure. Recovery is not an item and never appears on the bill.
We have not finished checking this source. No judgement either way. how we score evidence
Caveat on this rating: The overtreatment figure is an aggregate estimate with a wide band, not a finding about anyone's individual care. Population-level effects of payment systems say nothing about any individual clinician's reasoning, and the research does not claim otherwise - nothing here says your doctor is motivated by money.
A visit is an item. A test is an item. Recovery is not, so nobody bills for it.
That is not a conspiracy. It is an accounting choice made a long time ago, and the consequences have been measured.
Significant findings
Berwick and Hackbarth estimated in JAMA that overtreatment alone cost the US health system between $158 billion and $226 billion in 2011.
The definition is the part that matters. They defined overtreatment as care driven by providers' preferences rather than those of informed patients. Not fraud, not incompetence, not greed - preference, in the absence of an informed patient.
So the fix implied by the largest waste estimate in American healthcare is not a new payment model. It is a better-informed patient. That is you.
Worth asking
Whatever is recommended, ask three things. What are the alternatives, including doing nothing for now? How will we know whether this is helping, and by when?
And what would you want to be true before we consider stopping? That turns an open-ended prescription into a plan with an exit. Any medication change belongs in that conversation, never made alone.
Source
Eliminating waste in US health care — Berwick DM, Hackbarth AD (2012)
Read the source: https://doi.org/10.1001/jama.2012.362
DOI: 10.1001/jama.2012.362
How this was scored
- Study design
- not recorded
- Funding
- not recorded
- Published in
- not recorded
- Sample size
- not recorded
- Preregistered
- not recorded
- Conflicts disclosed
- not recorded
- Independent of proponent
- not recorded
- Retracted
- No
We have not finished checking this source, so there is no scoring to show yet. “We have not checked this yet” and “this is disputed” are different statements, so no scored band is shown rather than a low one.
Read the full scoring rubric, including what it can't tell you.
Published August 31, 2026.
Questions
How strong is the evidence behind this?
Resolv rates this source "not yet assessed". We have not finished checking this source. No judgement either way. One caveat travels with that badge: The overtreatment figure is an aggregate estimate with a wide band, not a finding about anyone's individual care. Population-level effects of payment systems say nothing about any individual clinician's reasoning, and the research does not claim otherwise - nothing here says your doctor is motivated by money. The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
Eliminating waste in US health care — Berwick DM, Hackbarth AD (2012). DOI: 10.1001/jama.2012.362. The full source is linked on this page so you can read it yourself.
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.