Patient Education

Reducing Spending on Wasteful, Unethical Lab Tests (Dr.Thangjam Dhabali Singh)

Dr.Thangjam Dhabali Singh Imphal

At 1.15 percent of its gross domestic product (GDP), India’s public health expenditure is one of the lowest in the world.The country’s healthcare need has been left mostly to the private sector to service. It is in the backdrop of this scenario that the long-standing issue of the overuse of diagnostic tests and procedures has existed among diagnostic laboratories and other healthcare providers.

It is believed that ‘low-value’ medical lab tests and other overused procedures have led to wasteful healthcare spending. A number of factors have contributed to this, including increased consumer awareness and expectations.

An important driver for the wasteful practice is the culture of “more is better” fuelling the belief that more information, more tests, more scans and more interventions are better.There is also the case of “defensive medicine”, which is doctors protecting themselves against possible litigation arising from missing a diagnosis.

Then again, the practice of prescribing “panel” of tests feeds into the system where doctors ask for different panels that include parameters not entirely needed for the diagnosis of the disease. Examples: KFT instead of electrolytes (for monitoring electrolyte imbalance), Lipid Profile instead of triglycerides (when other lipids are normal), etc.

The aggressively marketed “Master Health Check-up” plans are also seen as an important contributor. Pushing the idea of timely detection of diseases and the benefits that accrue from it, many of the tests included have dubious value as screening tests.

Hospitals also contribute to the problem through duplicate ordering or repeating tests that have already been done elsewhere.

In India, especially in the tier-1 and tier-2 cities, the highly unethical “cut system” exists where the laboratory pays out to the referrer for sending them “business”. Known simply as cut, referral fee or commission, it means doctors have a selfish reason behind for sending patients for tests to the diagnostic facility that gives out the maximum cuts, irrespective to the quality of the services. This leads to doctors ordering a battery of tests purely for personal monetary gain. Mushrooming of laboratories without regulations is one of the root causes of such malpractices. The fallout is the trust deficit between patients and doctors, and the escalating costs of diagnostic tests and investigations.


The public and healthcare providers both need to be sensitised to the fact that “more” is not necessarily better in healthcare. The government spending on healthcare has to improve to curtail the commercialisation.More stringent mechanism to check unethical practices needs to be in place. And to minimise repeat tests, technology has to come in to make readily available the results through mobile devices of all previously done investigations every time a patient makes a visit to the doctor.There are no easy solutions though.

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