Physicians' decisions are the proximate cause of<unk> <unk> , though the potential incentives and penalties they face can influence their choices. Third-party payers and fee-for-service When public or private insurance cover expenses and doctors are paid under a fee-for-service (FFS) model, neither has an incentive to consider the cost of treatment, a combination that contributes to waste. Fee-for-service is a large incentive for overuse because<unk> <unk>  providers (such as doctors and hospitals) receive revenue from the overtreatment. Atul Gawande investigated Medicare FFS reimbursements in McAllen, Texas, for a 2009 article in the New Yorker. In 2006, the town of McAllen was the second-most expensive Medicare market, behind Miami. Costs per beneficiary were almost twice the national average. In 1992, however, McAllen had been almost exactly in line with the Medicare spending average. After looking at other potential explanations such as relatively poorer<unk>  or medical malpractice, Gawande concluded the town was a chief example of the overuse of medical services. Gawande concluded that a business culture (physicians viewing their practices as a revenue stream) had established itself there, in contrast to a culture of low-cost high-quality medicine at the Mayo Clinic and in the Grand Junction, Colorado, market. Gawande advised: Medical malpractice laws and defensive medicine To protect themselves from legal prosecution U.S. physicians have an incentive to order clinically<unk>  tests or tests of little potential value. While defensive medicine is a favored explanation for high medical costs by physicians, Gawande estimated in 2010 it only contributed to 2.4% of the total $2.3 trillion of U.S.<unk> <unk>  spending in 2008. Direct-to-consumer advertising Direct-to-consumer advertising can encourage patients to ask for drugs, devices, diagnostics, or procedures. Sometimes service providers will simply give these treatments or services rather than attempting the potentially more unpleasant task of convincing the patient what they have requested is not needed, or is likely to cause more harm than good. Physician predispositions Dartmouth Medical School professor Gilbert Welch argued 2016 that certain predispositions by physicians and the general public may lead to<unk> , including: * Attempting to mitigate a risk without considering how small or unlikely the potential benefit is * Attempting to fix an underlying problem, instead of using a less-risky monitoring or coping strategy * Acting too quickly, when waiting for more information might be wiser * Acting without considering the benefits of doing nothing * Discounting downsides of diagnostic testing * Preferring newer over older treatments without considering the cost of new treatments or the effectiveness of older ones * Treating patients with terminal illness to maximize life span over quality of life, without probing a patient's preferences
Unnecessary health care
Drug disposal
Futile medical care
Medication costs
Consumer import of prescription drugs
Personal medicine
Public security
Urban legends about drugs