Article Critique: Hensher et al. on Medicine Overuse in Healthcare

This report provides a comprehensive critique of the article "Too much medicine": Insights and explanations from economic theory and research by Hensher, Tisdell, and Zimitat. The report begins with an introduction summarizing the authors' key arguments regarding the overconsumption of medicine, driven by factors such as health economics, behavioral economics, and ecological economics. The central arguments discussed include over-diagnosis, pharmaceuticalization, moral hazard, supplier-induced demand, and financial incentives for physicians. The critique analyzes the authors' claims, providing supporting evidence and contrasting viewpoints. The report then integrates the authors' conclusions, emphasizing the role of leadership and management in mitigating medicine overuse. It suggests strategies for healthcare leaders, such as educating providers, reducing incentives for unnecessary interventions, and regularly examining patient cases to identify overuse patterns. The report concludes by referencing the sources cited in the original article.

Running Head: MEDICINE OVERUSES
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Article Critique
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Table of Contents
Article to be discussed:................................................................................................................................2
Introduction.............................................................................................................................................2
Central arguments....................................................................................................................................3
Integration of the author's conclusion and implication for leaders and managements..............................6
References...................................................................................................................................................7

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Article to be discussed:
Hensher, M., Tisdell, J., Zimitat, C. 2017 “Too much medicine”: Insights and explanations from
economic theory and research in Social Science and Medicine, 176, pp. 77-84.
Introduction
The authors identified some key issues of providing too much medicine to the patients.
They stated that there in past few years the attention towards the issue of too many medicines has
been increased, whereby the diseased person gets treatment, and diagnosis unnecessarily which
providing them with little or no benefits, however, expose them to the risk of harm. Improper use
of healthcare resources takes place in a healthcare setting, which is not gaining the attention of
health economics. They considered the too much medicine as overconsumption, and draw the
research from three different aspects that are health economics, behavioural economics, and the
ecological economics, to examine the potential explanations and factor of overconsumption.
They defined the overconsumption as the circumstances in which the persons consume in a
manner that challenges their own health and wellbeing. The physicians are failed to act as the
patient's perfect agent, obstinate incentive are there for them to do deliver improper health
services, because of supplier-induced demands and the different forms of economic incentives.
They further stated that the evidence of behavioural economics deliver clear insight into the
reason of clinical practices might depart from the evidence-based treatment and care. They also
identified that the behavioural findings of health professionals approach for addressing the
uncertainty, and for evading possible regret, delivers rich explanations about the over usage and
overtreatment might often seem to be a rational choice in the process of decision making,
without thinking the about the risk of harm to the patient. The literature associated with

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ecological economics recommends that the prominence or positional competition can, through
the relationship of principal-agent in the health care deliver an additional pressure motivating the
overconsumption. The perspective of ecological economics also proposes the essential scope of
the interdisciplinary cooperation, the signal potentially essential problems for the assessment of
health technology, its management policies, and cultural change may require attaining the
important shifts in medical behaviour.
The authors have used a literature review as a method to identify the overconsumption issue and
its consequences. They used some online databases like PubMed, the web of science, and books.
Central arguments
Some of the main arguments discussed by the authors include;
The authors clearly stated the overconsumption by using the example of cancer. They reported
that in cancer the physicians frequently perform over-diagnosis to screen the cancer progression,
this increases the risk of harm to the patient, some of the researchers identified the side effects
associated with the cancer diagnosis (for example biopsy, and pad CT scan). These diagnostic
tests are also costly and enhance the risk to harm (Welch, Gilbert, and William Black 2010, 605-
613). However many researchers would not agree with the argument of the author as it is
necessary to diagnose the patient for cancer as it can regrow even after the treatment (Loeb et al
2014, 1046-1055). The authors also debated the concept of phrmaceuticalisation and its links to
the situation in which the application of the drug ceases to be the rationale, unsuccessful to
confer the advantages and risk harms deprived of the concomitant benefits. They reported that
this particular term is clearly a companion of over-medicalization.

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They further reported that the healthcare market considers different aspects in order to become
different from their competitors, thus they must also consider too much medicine issue. They
discussed steps of contextualising the term too much medicine. In the first steps, they discussed
how the concept related to the different care concepts within the ecological, sustainable
economics and health economics. In the second they mentioned the argument moral hazard
which means people with health insurance consumes additional health care compare to if they
are uninsured. And this impacts the overall consumption of medicine, although they also stated
the impacts are negative. In the third steps or implicit approach to the answer the question “how
much is too much” differentiate actual consumptions with the requirements of care. In this
section, they stated that too much medicine set out the provision of treatment in order to provide
benefits as well harms. They are less effective and costly for the patient (Morga et al 2015, 120-
124). They further revealed that too much medicine is the contributor to the aggregate
phenomenon of uneconomic growth which is represented by the increasing over-diagnosis and
overtreatment, and its contribution of wellbeing is negative. According to the authors, these
issues are also associated with moral hazard, behavioural economics, and cost-effectiveness. As
the patient is displaying a tendency to have overuse of medicine when they are insured form
different health insurance companies, as they have to spend the very low amount of money to
buy medicine and receive diagnosis and treatment services. Another argument made by the
authors is the role of supplier induced demand on the overuse of medicine. According to the
authors, when the number of doctors increasing in the high population areas, they start increasing
the number of health intervention or treatments for every patient in order to maintain the target
revenue to counteract the increased competition. These facts are also reported by different

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researchers in the past few years, and the authors supported these facts with strong evidence
(Brownlee et al 2017, 156-168).
One of the main argument of this article was the payment and financial incentives provided to
the physicians. The payment system used in the health care setting is unfavourable for the
consumers, as the doctors are provided with incentives for the utilisation of different diagnostics
tests and treatment per patient. According to the author, the well-designed payment mechanisms
should avoid providing incentives for unnecessary overutilization and evade rewarding them.
They further reported that the overconsumption of healthcare will tend to be encouraged by the
additional cost-effective health intervention choices. They also debated that the healthcare
organisation are only focusing on implementing new technologies and focusing on the
management of those technologies. The concept of medical arms has also been stated in the
article, they examined that the hospital settings in the highly competitive market seem to have
increased cost compared to the hospital have higher monopoly power. The arguments made by
the author are also supported by different researcher including Hanh, James, and Roice (Sheldon
2011). They identified that the higher levels of duplicated tech services are linked with increased
cost per discharge and reduces the operating margin. Behavioural economics is also associated
with the overuse of medicine. According to the authors, there are different evidence displays that
the people constantly show loss aversion" that places an increased value on evading the loss
instead of on getting an advantage of equivalent financial value. The concept of competitive and
positional consumption is also associated with overconsumption, stated by authors. They also
stated that consumption towards the goods and services has not only linked to their satisfaction
level and other’s consumption (Trinh et al 2008, 192-202).

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Overall the authors provided enough information about the overconsumption and over the use of
medicine and treatment services. They clearly discussed the facts that are supported by high
quality evidenced. They debated their reasons for over uses of medicines with strong evidence
and concluded the main facts in the end. However, they also lack in augmenting some aspects
that need more research and argumentation. For example, the argumentations on ecological and
sustainable economics were not mentioned clearly. They greatly stated the role of moral hazard
in the overuse of medicines, but there was a lack of evidence provided in the discussion. One of
the articles identified that under treatment might be beneficial but over treatment does not (Katz
2013, 93).
Integration of the author's conclusion and implication for leaders and management
In the conclusion part, the authors provide the main theme of the article and discussed the key
factor associated with the overuse of medicines. They concluded the key role of the physician in
enhancing the activities of overconsumption of treatment and medicines. They have clearly
concluded the arguments made in the article. The facts concluded by the author can be helpful to
understand the role of leadership and management in the healthcare department (Lipitz-
Snyderman, and Deborah 2013, 810-811). The arguments made by the authors clearly indicating
that through proper management and effective leadership the over usage of medicines and
intervention can be avoided and the patient safety can be increased. The manager sand leaders
are the one who has the authority to examine if there is any breach of using prescription and
treatment on the specific patient. The leader can educate the health care provider on how to use
minimum Amount of medicines, and reduce the number of diagnoses per patient (Morgan, et al
2017, 346). They can also have an idea from the article that by reducing the incentives on the
number of intervention and treatment per patient and stop rewarding them for unnecessarily

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examining the patient and prescribing additional medicines without even thinking of risk to
harm. The healthcare leaders can educate and provide leadership training to the doctors in order
to reduce the incidents of medicine and treatment overuses. The healthcare leader and manager
should examine every patient’s case in the healthcare setting monthly in order to identify the
causes of overconsumption (Arnold 2005, 280-284).

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References
1. Welch, H. Gilbert, and William C. Black. "Overdiagnosis in cancer." Journal of the
National Cancer Institute 102, no. 9 (2010): 605-613.
2. Loeb, Stacy, Marc A. Bjurlin, Joseph Nicholson, Teuvo L. Tammela, David F. Penson, H.
Ballentine Carter, Peter Carroll, and Ruth Etzioni. "Overdiagnosis and overtreatment of
prostate cancer." European urology 65, no. 6 (2014): 1046-1055.
3. Morgan, Daniel J., Scott M. Wright, and Sanket Dhruva. "Update on medical
overuse." JAMA internal medicine 175, no. 1 (2015): 120-124.
4. Brownlee, Shannon, Kalipso Chalkidou, Jenny Doust, Adam G. Elshaug, Paul Glasziou,
Iona Heath, Somil Nagpal et al. "Evidence for overuse of medical services around the
world." The Lancet 390, no. 10090 (2017): 156-168.
5. Sheldon, Tony. "Is competition law bad for patients?." Bmj 343 (2011): d4495.
6. Trinh, Hanh Q., James W. Begun, and Roice D. Luke. "Hospital service duplication:
evidence on the medical arms race." Health Care Management Review 33, no. 3 (2008):
192-202.
7. Katz, Mitchell H., Deborah Grady, and Rita F. Redberg. "Undertreatment improves, but
overtreatment does not." JAMA internal medicine 173, no. 2 (2013): 93-93.
8. Lipitz-Snyderman, Allison, and Deborah Korenstein. "Reducing overuse—is patient
safety the answer?." Jama 317, no. 8 (2017): 810-811.
9. Morgan, Daniel J., Aaron Leppin, Cynthia D. Smith, and Deborah Korenstein. "A
practical framework for understanding and reducing medical overuse: conceptualizing

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overuse through the patient-clinician interaction." Journal of hospital medicine 12, no. 5
(2017): 346.
10. Arnold, Cody. "Decreasing antibiotic overuse in neonatal intensive care units: quality
improvement research." In Baylor University Medical Center Proceedings, vol. 18, no. 3,
pp. 280-284. Taylor & Francis, 2005.