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

  • 1. Specialists

    2. 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*