Overtesting in Japan

From the 2018 HVPAA National Conference

Mano Soshi (Osaka Medical College), Takahiro Mizuta (Okayama University), Yasuharu Tokuda (Muribushi Okinawa)


Overtesting is a cause of unnecessary harm to patients and waste in healthcare. It can lead to downstream tests, invasive procedures, and unnecessary treatments with potential risk for complications. In Japan, little is understood about physician perspectives on the problem.


Our purposes were to evaluate physician perspectives on the prevalence, causes and potential solutions of overtesting in healthcare, and to have clues to reduce overtesting in Japanese healthcare.


We offered physician members of an online educational community in January 2018 to participate in a survey. The survey, based on the questionnaire developed by Lyu, explored physician perspectives on the prevalence, causes and potential solutions of overtesting in healthcare. We analyzed the outcome measures including percentage of unnecessary tests, major reasons for overtesting, and potential solutions.


A total of 940 physician members participated in the survey. Forty six percent of participants estimated that at least 30% of overall tests was unnecessary. Physicians reported estimates of major reasons for overtesting: fear of malpractice (69%), patient request (62%), and difficulty in accessing medical records (22%). In addition, 181 (19%) reported that pressure from employers of hospitals/clinics was a reason for overtesting. Top 3 potential solutions identified were training residents on appropriateness criteria, easy access to outside health records, and more practice guideline.


Our nationwide survey provided the chance to discover potential reasons and solutions of overtesting in healthcare in Japan. Effective solutions are likely multi-factorial and may include educational campaigns and systems change for sharing medical data.

Implications for the Patient

Our survey can be useful to identify reasons and solutions of overtesting in healthcare and lead to better care in a system that is more efficient and more effective.

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