Is less more, or is it less? The growing evidence on high-intensity hospital care

The evidence seems clear: we spend so much on healthcare, and get so little in return. Despite wide variation in the amount we spend on care, patients' outcomes are often the same.1 So clearly, we should just do less. Indeed, given the growing problems of overdiagnosis and overtreatment, less is more.

As emergency physicians, we deliver a fair amount of high-intensity care. Yes, good care can sometimes be as simple as an astute diagnosis or a kind word. But it can also involve cross-sectional imaging, invasive procedures and hospital admission. At the right time and for the right patient, we believe, this care can be the difference between life and death.

And yet this care is coming under increasing scrutiny from payers and policy makers.

While emergency care accounts for a small fraction of direct health system costs,2 the decision to admit a patient to the hospital is an...

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