Overtreatment and Overmedication in India

GS-II | Social Justice | Health | Government Policies and Interventions | Issues Related to Development and Management of Social Sector

Why in News?

·         Today, modern healthcare systems are able to detect, prevent and treat disease more than ever before. Unfortunately, these systems are also becoming more prone to excessive treatment and medication.

·         In India, there is a dual problem of overtreatment and undertreatment. On one hand, some people are getting too much treatment (unnecessary medical procedures); on the other hand, many people are not receiving the basic medical care they need, including access to affordable drugs and early intervention.

Overtreatment and Overmedication: Meaning

• Overtreatment: When a person has unnecessary healthcare services such as testing, treatments, procedures or operations that do not benefit him/her.
• Overmedication: The utilization of unneeded medications or the continued use of medications that are likely no longer required.
• Cascade of Care: An incidental finding on a test results in further evaluation, a definitive diagnosis and a prescription, which may result in a long-term treatment plan.

Major Causes of Overtreatment and Overmedication

• Excessive Testing: Overly aggressive screening and diagnostic testing may result in false-positive findings, increased levels of patient anxiety, additional testing, overdiagnosis and unnecessary treatment.
• Lack of Coordination of Healthcare: Over-reliance on specialty/super-specialty care often results in numerous prescriptions for a single patient, with no consideration given to other potential health issues that the patient may have.
• Polypharmacy among Older Adults: A systematic review and meta-analysis of Indian studies published in Frontiers in Pharmacology in 2021 indicated that approximately 49% of older adults experience polypharmacy. In 2025, a study conducted in Scientific Reports showed that approximately one-third of older adults were prescribed five or more medications; of those adults, 28.8% had been given potentially inappropriate medications.
• Commercialisation of Healthcare: The commercialisation of healthcare has made laboratory testing, imaging studies, medical procedures, dietary supplements and patient monitoring technology into goods that are marketed and purchased. At times, this process has blurred the line between what is required for proper treatment and what is optional.
• Fee-for-Service Model: The way healthcare is paid for may lead to more tests/procedures being ordered than would be done if money was based on keeping things under control. Most people feel that they have completed their visit to a physician once they receive a list of medications and/or diagnostic tests to perform.
• Health Insurance and Moral Hazard: The use of health insurance can lead to two types of moral hazards—one that occurs prior to seeking medical treatment (ex-ante) and the other after having received the treatment (ex-post). Both of these types of moral hazards can lead individuals to seek fewer preventive treatments and instead choose to receive more expensive and extensive treatments once they become ill.
• Patient Expectations: Patients often find reassurance, observation and lifestyle advice less concrete than having a scan or prescription.
• Defensive Medicine: Clinicians may order more tests than necessary due to their concern about not missing an unusual diagnosis; however, they often overlook the potential risks of the testing and the possible discovery of incidental findings.

Consequences of Overtreatment and Overmedication

• Patient Harm: When patients receive excessive testing or treatment, there is a risk of exposing them to possible risks associated with abnormalities that would have remained harmless without intervention.
• Overdiagnosis: An incidental finding may result in further evaluation and/or management when it has no significant benefit.
• Polypharmacy: An increased number of medications requires assessment of their indications, potential advantages, redundancy and interactions.
• Financial Pressure: Unwarranted testing, prescriptions and surgical interventions contribute to an increase in healthcare costs.
• Healthcare Inequality: The inequality in healthcare has two sides. On one hand, many people have too much done to them in the form of tests and procedures that they do not need. On the other hand, many people are not receiving the basic medical services that they require, including primary care, inexpensive prescription drugs and prompt treatment for serious illnesses.

Choosing Wisely: Global Initiative

• Background: The global Choosing Wisely initiative was created as a result of an increasing awareness of overtreatment.
• Objective: To promote awareness among both patients and healthcare providers that will help lead to more careful consideration when choosing medical treatments.
• Recommendations: From 2012–2023, almost 80 different specialty organisations around the world produced close to 700 recommendations identifying tests and treatments that medical professionals and their patients may want to consider questioning.
• Need for Self-Correction: Better healthcare requires more effective ways of self-correcting when errors occur and limiting the amount of unnecessary treatments provided.

Way Forward

• Enhance Primary Care: Create a functioning system of primary care and reinstate the role of the family doctor as the primary source of medical attention for many types of non-emergency health issues.
• Coordination of Care: A primary care physician (general practitioner) should recognise when a patient has medical conditions that require specialised knowledge, coordinate all of the patient’s medications and know when a patient’s medication regimen may be scaled back without risking the patient’s health.
• Periodic Medication Reviews: All prescriptions need to have a review date and, as appropriate, a potential end date. Structured medication reviews are required for older adults and individuals who are taking five or more medications.
• Develop India-Specific Lists: Professional medical organisations and the Indian Council of Medical Research can create India-specific lists of low-value diagnostic tests, therapies and procedures in a manner similar to Choosing Wisely.
• Medical Education and Licensure: Incorporate these principles into medical education, certification and quality-improvement programmes.
• Measure Avoidance of Unnecessary Care: Hospitals need to evaluate not just what recommended care was received by a patient, but also whether they have been able to prevent giving unnecessary care to a patient.
• Promote Informed Patient Decisions: Prior to beginning a procedure or treatment, patients need to find out:
  • Why do I need this?
  • What happens if I wait?
  • What are the possible benefits and risks?
  • What are the alternatives?
• Reform Healthcare Payments: For health insurance and payment systems to be successful, they need to base rewards on the results of treatment (outcomes), the thought processes behind clinical decisions (reasoning) and the ability of patients to continue receiving the same quality of care throughout their lifetime (continuity of care), as opposed to being solely based upon the number of treatments performed (volume).

Conclusion

Medical advancements will occur; however, measuring medical progress solely based on the number of new tests, medications and treatments is insufficient. We must also determine what to do when we have no other options. Developing stronger primary care systems, evaluating existing prescriptions, creating India-specific lists of low-value interventions and allowing patients to make informed decisions regarding their treatment plan may assist with reducing overtreatment and overmedication.

When treating a patient, it is essential to act when the action is beneficial to the patient. However, due to the availability of numerous medical treatments, there is an ever-growing need to exercise restraint.

UPSC Mains Practice Question

Q. Overtreatment and overmedication exist side-by-side with undertreatment in the Indian healthcare system. Discuss the main reasons why this happens, and propose ways to encourage proper treatment and patient-centred healthcare.

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