▁documented ▁harm ▁to ▁patients ▁from ▁over use ▁of ▁sur ger ies ▁and ▁other ▁treat ments . ▁ ▁C aus es ▁Phys icians ' ▁dec isions ▁are ▁the ▁proxim ate ▁cause ▁of ▁unnecessary ▁care , ▁though ▁the ▁potential ▁in cent ives ▁and ▁pen alt ies ▁they ▁face ▁can ▁influence ▁their ▁choices . ▁ ▁Third - party ▁pay ers ▁and ▁fee - for - service ▁ ▁When ▁public ▁or ▁private ▁ins urance ▁cover ▁exp enses ▁and ▁do ctors ▁are ▁paid ▁under ▁a ▁fee - for - service ▁( FF S ) ▁model , ▁neither ▁has ▁an ▁in cent ive ▁to ▁consider ▁the ▁cost ▁of ▁treatment , ▁a ▁combination ▁that ▁cont ributes ▁to ▁waste . ▁F ee - for - service ▁is ▁a ▁large ▁in cent ive ▁for ▁over use ▁because ▁health ▁care ▁prov iders ▁( such ▁as ▁do ctors ▁and ▁hosp it als ) ▁receive ▁re venue ▁from ▁the ▁over tre at ment . ▁ ▁At ul ▁G aw ande ▁investig ated ▁Medic are ▁F FS ▁re imb urs ements ▁in ▁Mc All en , ▁Texas , ▁for ▁a ▁ 2 0 0 9 ▁article ▁in ▁the ▁New ▁York er . ▁In ▁ 2 0 0 6 , ▁the ▁town ▁of ▁Mc All en ▁was ▁the ▁second - most ▁expensive ▁Medic are ▁market , ▁behind ▁Miami . ▁Cost s ▁per ▁benef ici ary ▁were ▁almost ▁twice ▁the ▁national ▁average . ▁ ▁In ▁ 1 9 9 2 , ▁however , ▁Mc All en ▁had ▁been ▁almost ▁exactly ▁in ▁line ▁with ▁the ▁Medic are ▁sp ending