higher-spending regions receive more care than those in lower-spending regions, but do not have better health outcomes or satisfaction with care." In January 2012, the American College of Physicians Ethics, Professionalism, and Human Rights Committee suggested that overtreatment can also be understood in contrast to 'parsimonious care', defined as "care that utilizes the most efficient means to effectively diagnose a condition and treat a patient." In April 2012, Berwick, from the Institute for Healthcare Improvement, and Andrew Hackbarth from the RAND Corporation defined overtreatment as "subjecting patients to care that, according to sound science and the patients' own preferences, cannot possibly help them—care rooted in outmoded habits, supply-driven behaviors, and ignoring science." They wrote that trying to do something (treatment or testing) for all patients who might need it inevitably entails doing that same thing for some patients who might not need it." In uncertain situations, "some non-beneficial care was the necessary byproduct of optimal clinical decision making." In October 2015, two pediatricians said that considering "overtreatment as an ethical violation" could help see the conflicting incentives of health care workers for treatment or nontreatment. Low-value health care, for the most part, is administration of tests or treatment, which though useful initially, offer little value if given repeatedly as a part of routine care. Cost In the US, the country which spends the most on health care per person globally, patients have fewer doctor visits and fewer days in hospitals than people in other countries do, but prices are high, there is more use of some procedures and new drugs than elsewhere, and doctor salaries are double the levels in other countries. The New York Times reported "no one knows for sure" how much unnecessary care exists in the United States. Overuse of medical care is no longer a large fraction of total health care spending, which was $3.3 trillion in 2016. Researchers in 2014 analyzed many services listed as low value by Choosing Wisely and other sources. They looked at spending in 2008–2009 and found that these services represented 0.6% or 2.7% of Medicare costs and there was no significant pattern of particular types of physicians ordering these low value services. The Institute of Medicine in 2010 gave two estimates of "unnecessary services," using different methodologies: 0.2% or 1% to 5% of health spending, which was trillion. The Institute of Medicine quoted that 2010 report in a 2012 report