India’s Problem of Overtreatment and Overmedication: Causes and Solutions

GS Paper II: Issues relating to the development and management of Social Sector/Services relating to Health.

Context: India faces a dual healthcare challenge: overtreatment among some sections and inadequate access to essential healthcare among others, raising concerns about patient safety, affordability and quality of care.

About Overtreatment and Overmedication

• Overtreatment: Providing tests, procedures or therapies when their potential risks outweigh their expected benefits.
• Overdiagnosis: Identifying abnormalities or conditions that would never have caused symptoms or harm during a person’s lifetime.
• Incidentaloma: An unexpected abnormality discovered during an investigation conducted for another purpose.
• Polypharmacy: The use of multiple medicines by one patient, which may increase the risk of adverse drug interactions, particularly among older adults.

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Major Causes

• Unnecessary Testing: Routine health packages and indiscriminate screening may produce false-positive results, anxiety and unnecessary follow-up procedures. 
  • A 2016 review in The National Medical Journal of India highlighted concerns regarding inappropriate tests in routine health check-ups.
• Fragmented Healthcare: Multiple specialists may prescribe overlapping or conflicting treatments without a comprehensive review of the patient’s health.
• Commercialisation of Healthcare: Fee-for-service models may incentivise greater use of tests and procedures rather than better patient outcomes.
• Insurance-Related Incentives: Insurance coverage may encourage excessive utilisation when patients or providers perceive treatment as having little direct cost.
• Patient Expectations: Patients may associate more medicines and tests with better treatment, while doctors may prescribe them to meet expectations.
• Defensive Medicine: Fear of litigation may lead doctors to order additional tests to minimise the risk of missing a diagnosis.

Way Forward

• Strengthen Primary Care: Revitalise primary healthcare centres and family physicians to coordinate treatment and reduce unnecessary specialist referrals.
• Rationalise Prescriptions: Introduce regular medication reviews, clear treatment durations and deprescribing where clinically appropriate.
• Develop Choosing Wisely Guidelines: The Indian Council of Medical Research (ICMR) and medical associations should promote evidence-based lists of low-value tests and procedures.
• Empower Patients: Encourage patients to ask about the necessity, benefits, risks and alternatives of proposed tests and treatments.
• Shift to Outcome-Based Healthcare: Align provider payments and insurance incentives with quality, safety and patient outcomes rather than the volume of services delivered.

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Conclusion

India must move from more healthcare to better healthcare, ensuring that every test, medicine and procedure is evidence-based, necessary, safe and accessible.

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