Influence of Patient and Provider Characteristics on the Overuse of Health Care Service

Objective: To examine the association between patient- and provider-level characteristics and utilization of five low-value health care services and to estimate the prevalence and costs of those services.;Methods: This study uses 2012 administrative claims data from an Upper Midwest health plan on enrollees who were at risk of receiving five commonly overused services, including: (1) Pap tests performed on females younger than 21 years old. (2) HPV tests performed on females younger than 30 years old. (3) PSA tests performed on male patients 75 years and older. (4) Colorectal cancer screening tests performed on patients older than 75 years old. (5) Imaging tests for non-specific low back pain within four weeks of diagnosis. I used a two-level mixed-effects probit model to estimate the association between patient and provider characteristics and occurrence of selected services.;Results: The prevalence varied across services from 2.3 percent to 17.4 percent, and generated $1.38 million in allowed charges in one year. Probabilities of cervical cancer screening overuse increased with age for girls, and the probabilities for prostate and colorectal cancer screening declined with age for the elderly. Individuals with moderate and high health risks were more likely to receive low-value services, but the probability decreased for the highest risk category. Medicare enrollment was associated with increased utilization of low-value preventive cancer screenings. Some neighborhood socio-economic determinants were associated with overuse; these included a greater proportion of White residents, less well-educated residents, and neighborhoods with low poverty rate. After controlling for both patient and provider characteristics, overuse was positively associated with older providers, specialists, and physicians, as opposed to other non-physician clinicians.;Conclusions: Overall, this study expanded on prior literature by examining additional provider characteristics associated with overuse. The patient- and provider level correlates and their relative contribution varied for the five selected services.