TY - JOUR

T1 - Perspectives from China, India and Sri Lanka on the drivers and potential solutions to overuse and overdiagnosis

AU - Pathirana, Thanya

AU - Wang, Yu

AU - Martiny, Frederik

AU - Copp, Tessa

AU - Kumar, Raman

AU - Mendis, Kumara

AU - Tang, Jinling

PY - 2023

Y1 - 2023

N2 - Overuse is defined as provision of healthcare which is more likely to result in harm than good, and it is fast becoming a threat to human health and the sustainability of health systems worldwide.1 Overuse may, but not always, increase the risk of overdiagnosis, which occurs when someone is diagnosed with a disease that would have never caused them harm if not recognised and is a well-known adverse outcome of screening.2 ,3 Overuse and overdiagnosis have a different signification when it occurs in LMICs, where wise utilisation of the already limited healthcare resources is paramount, especially in the COVID-19 pandemic era.1 4 5Overuse and overdiagnosis have drawn much attention in high-income countries (HICs), from which most of the existing empirical evidence derives, but have received little recognition in LMICs, although the evidence is growing.6 While some similarities exist, the drivers and potential solutions for overdiagnosis and overuse in LMICs may differ substantially to those in HICs, due to complex and diverse socioeconomic, political and cultural backgrounds in LMICs. Overuse especially threatens the sustainability of already constrained health systems in LMICs, draining the resources that could potentially be used to address underutilisation.7 However, emphasising this issue may be regarded as undesirable, counterintuitive and even politically challenging within the established climate of underdiagnosis and underutilisation of healthcare resources in LMICs.5We attempt to describe the possible drivers and solutions for overuse and overdiagnosis in LMICs with examples from empirical literature focusing on China, India and Sri Lanka. These drivers and proposed solutions identified were collectively informed by the authors’ own experience in working in healthcare and research settings in the aforementioned countries, a review of the published literature and participant discussions during a workshop at the international Preventing Overdiagnosis Conference, in 2019.5 During the latter, in small groups, the workshop participants were given the opportunity to discuss, identify and map key drivers to potential solutions for overuse and overdiagnosis in LMICs, which were then shared with the wider group.While we acknowledge that the themes described here may not comprehensively represent all drivers and solutions to overdiagnosis and overuse, nor may they be generalisable to other LMICs, we hope this will provide a useful gateway to further discussion and vital research of this under-recognised but growing problem for our countries.

AB - Overuse is defined as provision of healthcare which is more likely to result in harm than good, and it is fast becoming a threat to human health and the sustainability of health systems worldwide.1 Overuse may, but not always, increase the risk of overdiagnosis, which occurs when someone is diagnosed with a disease that would have never caused them harm if not recognised and is a well-known adverse outcome of screening.2 ,3 Overuse and overdiagnosis have a different signification when it occurs in LMICs, where wise utilisation of the already limited healthcare resources is paramount, especially in the COVID-19 pandemic era.1 4 5Overuse and overdiagnosis have drawn much attention in high-income countries (HICs), from which most of the existing empirical evidence derives, but have received little recognition in LMICs, although the evidence is growing.6 While some similarities exist, the drivers and potential solutions for overdiagnosis and overuse in LMICs may differ substantially to those in HICs, due to complex and diverse socioeconomic, political and cultural backgrounds in LMICs. Overuse especially threatens the sustainability of already constrained health systems in LMICs, draining the resources that could potentially be used to address underutilisation.7 However, emphasising this issue may be regarded as undesirable, counterintuitive and even politically challenging within the established climate of underdiagnosis and underutilisation of healthcare resources in LMICs.5We attempt to describe the possible drivers and solutions for overuse and overdiagnosis in LMICs with examples from empirical literature focusing on China, India and Sri Lanka. These drivers and proposed solutions identified were collectively informed by the authors’ own experience in working in healthcare and research settings in the aforementioned countries, a review of the published literature and participant discussions during a workshop at the international Preventing Overdiagnosis Conference, in 2019.5 During the latter, in small groups, the workshop participants were given the opportunity to discuss, identify and map key drivers to potential solutions for overuse and overdiagnosis in LMICs, which were then shared with the wider group.While we acknowledge that the themes described here may not comprehensively represent all drivers and solutions to overdiagnosis and overuse, nor may they be generalisable to other LMICs, we hope this will provide a useful gateway to further discussion and vital research of this under-recognised but growing problem for our countries.

KW - diagnosis

KW - CORRUPTION

KW - MEDICINE

UR - https://ebm.bmj.com/content/early/2022/08/11/bmjebm-2021-111869

U2 - 10.1136/bmjebm-2021-111869

DO - 10.1136/bmjebm-2021-111869

M3 - Editorial

C2 - 35961768

VL - 28

JO - BMJ Evidence-Based Medicine

JF - BMJ Evidence-Based Medicine

SN - 2515-446X

IS - 2

ER -