Article Critique: Overuse of Medicines and Healthcare Implications

This report presents a detailed critique of an article discussing the overuse of medicines within the healthcare system, focusing on the work of Hensher, Tisdell, and Zimitat. The critique analyzes the authors' central arguments and conclusions, which encompass behavioral and health economics, supplier-induced demand, moral hazard, and competitive positional overuse. The article explores how factors like doctor and consumer behavior, payment systems, and pharmaceutical incentives contribute to overconsumption, potentially leading to unnecessary treatments and patient harm. The critique evaluates the evidence supporting these arguments, identifies areas where further research is needed, and discusses the implications of the findings for health leadership and management, particularly in addressing overdiagnosis, overtreatment, and the effective education of patients.

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Table of Contents
Article brief.................................................................................................................................................2
Central arguments and conclusions.........................................................................................................3
Author’s conclusion implications................................................................................................................6
References...................................................................................................................................................8

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Article brief
There is a number of facts have been discussed by Hensher, Tisdell and Zimitat regarding the
problems associated with using overuses of the medicine in healthcare. The authors clearly
discussed how different aspects are contributing to the overconsumption of the medicines
including the behaviour of doctors and consumers, and economic aspects. These issues are
increasing in the healthcare sector day by day to cope with the competition and requirement of
the clients. The article clearly denied that the overuses of these drugs affecting the patient
negatively and increasing the risk of harm. The authors defined the overconsumption and
identified the situations in which the person consumes extra medicines and receiving treatment
unnecessarily. They draw their research from the role of health economics, behavioural
economics, and ecological economics in over-consumption. The authors also reported that there
is robust evidence of the presence of supplier-induced request, and of the influence of numerous
practices of financial incentives on medical activities. The behavioural economics associated
evidence delivers strong visions on why the medical practice might not follow “evidence-based”
method in the healthcare setting. Additionally, behavioural conclusion on health specialists’
approaches for addressing the improbability, and for evading possible regret, deliver powerful
clarifications of why overuse or overconsumption and overtreatment might often give the
impression to be the first choice in the medical decision-making process, even when they are
prone to cause harm to the patient. Studies conducted on the ecological economics recommends
that status or positional rivalry can, through the principal-agent association in the healthcare
sector, offer an additional power triggering overuses. The authors synthesise the information
from different researches conducted on overuse or overconsumption and overtreatment.

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Central arguments and conclusions
Overconsumption in the healthcare
The authors reported that the majority of the research conducted is associated with the over
diagnosis in the context of cancer, however, it becomes more widespread. Over-diagnosis takes
place when the disease is recognised, and even continues even after the treatment to identify the
regrowth of cancer. The diagnosis tests performed on the patient affecting their health condition
instead of providing any health benefits. The healthcare providers provide medicines to the
patients without even thinking of the risk to harm it may pose on the patients (Joan 2015, 199-
2016). Hensher, Tisdell and Zimitat also discussed that the healthcare organisation are in a strong
competitive world, therefore, they have to attract more patient and provide the best treatment,
this ultimately leads to the overuse of medicines. They further discussed the role of supplier
induced demand on the overconsumption of medication. Authors identified that, when the
population of clinicians increases in the high populace areas, they begin to increase the amount
of health intercession or managements for each patient in to uphold the target income to cope
with the increased rivalry in the health care sector.
Payment system
This has become the main encouragement for the physicians to over-diagnose and perform
overtreatment per patient. The payment scheme used by health care organisation is critical for
the patient, as the doctors are providing with inducements or incentives for the applying more
diagnosis and treatments to address the diseases per patient (Ray et al 2016). They also précised
the signals about the availability of other methods associated with economic conflict of interest
which might disturb health care professionals’ medical behaviour towards the patient’s health.
They classify strong indication of considerable impacts on the medical decision-making when

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the doctors can self-refer diseased person to themselves for particular service delivery, and once
they can refer the diseased person to amenities or facilities in which they can earn more money.
This presenting that such straight economic incentives can motivate excess consumption when
associated with the referral designs of doctors deprived of these conflicts of interest (Isfahani
2013, 26). Hensher, Tisdell and Zimitat additionally examined different evidence concluding that
a variety of incentives from pharmaceutical companies have been exposed to influence on
doctor’s prescribing behaviour. The more they prescribe the drugs of a specific organisation, the
more they earn money.
The role of moral hazard and Cost-effectiveness
Hensher, Tisdell and Zimitat further discussed the role moral hazard and cost effectiveness of the
healthcare treatments and medication in the overuse and identified that Moral hazard defines the
common tendency of the patients for the availability of insurance to challenge the inducements to
stop or reduce the price of the protected risk happening. In health cover, the concept of moral
hazard is usually mentioned to as the propensity for persons to consume additional health care
treatments and medicines compared to when they have no health insurance as they now
experience a reduced marginal price of healthcare (Baicker et al 2013, 2). This encourages them to
have consumed more medicines and get additional diagnosis and treatment. The
Overconsumption of prescribed medicines and treatment is influenced by the more cost-effective
choices; overtreatment commonly symbolizes unnecessary and cost-ineffective upkeep (Adam et
al 2017, 191-202).
Supplier induced demands

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This is another main argument discussed by the authors. The supplier's induced demand
suggests that control and asymmetric info enable doctors to persuade demand by advising
processes or healthcare interventions even when the medical evidence proposes that the prices of
the process to the diseased person outweigh the advantages (Mulley 2009). They successfully
described that the healthcare organisation pose additional demand to the doctors to implement
unnecessary treatment and interventions that are not that effective as they cost.
Role of Behavioural economics and health care
They also argued that Behavioural economics is similarly linked with the overconsumption of
medicine. Hensher, Tisdell and Zimitat identified different research evidence shows that the
persons continually show loss aversion that source an augmented value on escaping the loss as
an alternative of on getting a benefit of comparable financial importance.
Competitive positional overuse
The authors further reported that the notion of competitive and positional use of treatment and
medicines is also related to the overconsumption, reported by Hensher, Tisdell and Zimitat. They
similarly reported that use of goods and facilities have not lone associated with the satisfaction
level of the patient but also linked with the use of goods and services by others. The individual
satisfaction derives from goods and facilities are contingent on increasing measure on the
consumption of own and others as well. The medicine and facilities being used up are therefore
helping partly as substitutions for the societal status that persons actually wish to carry. This
result in a trap for both persons and community: as revenues rise, individuals follow each other
in using more medications and treatment but received no long-lasting benefits in health (Morgan
et al 2015).

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Hensher, Tisdell and Zimitat also suggested that the working description of “too much medicine”
is, debatably, very much an illustration of perception of mis-consumption. An emphasis on mis-
consumption consequently includes a more precise focus on the prices, harms and advantages of
particular intercessions. This recognition of mis-consumption display the emphasis of the “too
much medicine” drive on stopping persons from suffering harm by needless treatment and
medication.
Author’s conclusion implications
The authors have evidently discussed the issues of too many medicines in the article. They
mentioned the key areas where the healthcare organisation is lacking in providing quality service
sot with the patient. They clearly examined the main practices increasing the overconsumption or
overuse of medicines in the healthcare setting. Although they clearly debated and define the
overconsumption in health care, still they lack in providing enough support for some arguments
for examples the behavioural economics are not evident with strong references. More research is
required to identify the actual root causes of using too much medication in healthcare. The
authors successfully debated the role of the incentive system used in healthcare to encourage the
overconsumption of treatment and medicines. The moral hazard associated issues are quite
effective and supported by strong evidence. The role of the pharmaceutical organisation in the
overuse of medicine is quite convincing and the authors made their point clearly. The main
arguments discussed by Hensher, Tisdell and Zimitat can in help identifying the role of
healthcare leaders and management in addressing such issues in their organisation. The
healthcare leaders must examine the healthcare setting regularly to identify any overconsumption
is takes place. They must take feedback from the patient and their families about the serviced and

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treatments provide in the department. This will help the leaders to identify whether the over
diagnosis, overtreatment, and over the use of medicines practices happening in the setting or not.
The facts discussed by the authors including the patient’s behaviours towards the treatment
medication (Pathirana et al. 2017), can help the healthcare leaders and management to educate
them about how the overconsumption can worsen their health conditions, and overshadow the
benefits of the treatment compared to their prices. The healthcare leader can also use their
leadership skills and educate the physicians to not overusing medicine and treatment as it
increases the risk of harm and may reduce patient satisfaction.

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References
Baicker, Katherine, Sendhil Mullainathan, and Joshua Schwartzstein. "Behavioral hazard in health
insurance." National Bureau of Economic Research bulletin on aging and health 1 (2013): 2.
Busfield, Joan. "Assessing the overuse of medicines." Social Science & Medicine 131 (2015):
199-206.
Elshaug, Adam G., Meredith B. Rosenthal, John N. Lavis, Shannon Brownlee, Harald Schmidt,
Somil Nagpal, Peter Littlejohns, Divya Srivastava, Sean Tunis, and Vikas Saini. "Levers
for addressing medical underuse and overuse: achieving high-value health care." The
Lancet 390, no. 10090 (2017): 191-202.
Isfahani, Sakineh Saghaeiannejad, Ahmad Reza Raeisi, Asghar Ehteshami, Hassan Janesari,
Avat Feizi, and Razieh Mirzaeian. "The role of evaluation pharmacy information system
in management of medication related complications." Acta Informatica Medica 21, no. 1
(2013): 26.
Martin, Stephen A., Scott H. Podolsky, and Jeremy A. Greene. "Overdiagnosis and
overtreatment over time." Diagnosis 2, no. 2 (2015): 105-109.
Morgan, Daniel J., Shannon Brownlee, Aaron L. Leppin, Nancy Kressin, Sanket S. Dhruva, Les Levin,
Bruce E. Landon et al. "Setting a research agenda for medical overuse." Bmj351 (2015): h4534.
Moynihan, Ray, Paul Glasziou, Steven Woloshin, Lisa Schwartz, John Santa, and Fiona Godlee.
"Winding back the harms of too much medicine." (2013): f1271.

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Mulley, Albert G. "Inconvenient truths about supplier induced demand and unwarranted
variation in medical practice." Bmj339 (2009): b4073.
Pathirana, Thanya, Justin Clark, and Ray Moynihan. "Mapping the drivers of overdiagnosis to
potential solutions." Bmj 358 (2017): j3879.