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Perspectives from China, India and Sri Lanka on the drivers and potential solutions to overuse and overdiagnosis
  1. Thanya Pathirana1,2,
  2. Yu Wang3,
  3. Frederik Martiny4,5,
  4. Tessa Copp6,
  5. Raman Kumar7,
  6. Kumara Mendis8,
  7. Jinling Tang9
  1. 1 Institute for Evidence Based Healthcare, Bond University, Gold Coast, Queensland, Australia
  2. 2 School of Medicine and Dentistry, Griffith University, Sunshine Coast, Queensland, Australia
  3. 3 Department of Global Health, School of Public Health, Peking University, China
  4. 4 The Research Unit and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
  5. 5 Center for Social Medicine in the Capital Region, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
  6. 6 Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, NSW, Australia
  7. 7 Academy of Family Physicians of India, New Delhi, Delhi, India
  8. 8 Department of Family Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
  9. 9 School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
  1. Correspondence to Dr Thanya Pathirana, School of Medicine and Dentistry, Griffith University, Sunshine Coast, Queensland, Australia; thanindu{at}

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Overuse is defined as provision of healthcare which is more likely to result in harm than good, and it is fast becoming a threat to human health and the sustainability of health systems worldwide.1 Overuse may, but not always, increase the risk of overdiagnosis, which occurs when someone is diagnosed with a disease that would have never caused them harm if not recognised and is a well-known adverse outcome of screening.2 ,3 Overuse and overdiagnosis have a different signification when it occurs in LMICs, where wise utilisation of the already limited healthcare resources is paramount, especially in the COVID-19 pandemic era.1 4 5

Overuse and overdiagnosis have drawn much attention in high-income countries (HICs), from which most of the existing empirical evidence derives, but have received little recognition in LMICs, although the evidence is growing.6 While some similarities exist, the drivers and potential solutions for overdiagnosis and overuse in LMICs may differ substantially to those in HICs, due to complex and diverse socioeconomic, political and cultural backgrounds in LMICs. Overuse especially threatens the sustainability of already constrained health systems in LMICs, draining the resources that could potentially be used to address underutilisation.7 However, emphasising this issue may be regarded as undesirable, counterintuitive and even politically challenging within the established climate of underdiagnosis and underutilisation of healthcare resources in LMICs.5

We attempt to describe the possible drivers and solutions for overuse and overdiagnosis in LMICs with examples from empirical literature focusing on China, India and Sri Lanka. These drivers and proposed solutions identified were collectively informed by the authors’ own experience in working in healthcare and research settings in the aforementioned countries, a review of the published literature and participant discussions during a workshop at the international Preventing Overdiagnosis Conference, in 2019.5 During …

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  • TP and YW are joint first authors.

  • Twitter @Thanya_Indu, @FrederikMartiny

  • Contributors TP and YW conceived the idea and wrote the first draft. TC, FM, RM, KM, JT reviewed and approved for submission. TIP and YW are responsible for the overall content as guarantors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests YW's spouse works for BMJ China. JT is the clinical research editor of the BMJ.

  • Provenance and peer review Not commissioned; externally peer reviewed.