Our healthcare industry is a tremendous force in our country coming in at $3.5 trillion dollars per year and 18% of our gross domestic product. Despite spending approximately $10,000 per American we fall behind other countries in the world on many important health quality measures. The Dartmouth Atlas of Health Care is a very interesting project started 20 years ago to track discrepancies in healthcare spending from one area of our country to another. For example, rates of spinal surgery or cardiac stents from one city or rural area to another controlling for factors such as population, age, diagnosis, co morbidities, and quality of life. Despite increases in spending these areas do not show higher health care outcomes. It is said this was one of the main talking points for our recent healthcare reform. Increased spending without an increase in outcomes.

Authors report up to 30% of worldwide healthcare spending can be attributed to overuse, misuse, or abuse (Brownlee et al. Lancet. 2017) . These dollars do not improve patient outcomes and likely harm patients with incorrect diagnoses, as well as, unnecessary testing and procedures. In the musculoskeletal system we see our fair share of wasted healthcare resources including imaging, office visits, and surgery. Importantly, our most expensive procedures such as spinal fusion continue to be utilized for patients with chronic low back pain despite evidence against its’ utilization for this patient population. Interestingly, we have seen nice studies comparing sham or placebo surgery to surgery for common orthopedic conditions. Authors report no significant difference between sham or surgical interventions for knee meniscal tears, knee osteoarthritis, shoulder labral tears and shoulder impingement.

Unfortunately, despite the evidence these arthroscopic surgeries continued to be performed with high frequency within our country. As our healthcare debate rages from Washington to Wall Street to Main Street we can find common ground on reducing this 30% of healthcare costs. Instead we should utilize our country’s health care personnel, facilities, research, and treatment options to those who need it most.