BACKGROUND: Overuse and underuse of healthcare services
occure within population, organizations and even patients around
the world. Producing a balance between these two can increase
efficiency, service quality and patient satisfaction. It also decrease
extra costs. The aim of this study was to identify forces for change
and forces against change for generating balance between overuse
and underuse to achieve right care.
METHODS: This study was conducted in five steps: 1) describe
our plan or proposal for change; 2) identify forces for change; 3)
identify forces against change; 4) assign forces; and 5) analyze and
apply. We used purposive sampling strategy. The number of
participants in the expert panel were eight. Each participant signed
informed consent form before starting the study (Ethical code:
RESULTS: The driving factors for balancing overuse and
underuse were education, preparing clinical guideline and
standard protocols, resource allocation, using evidence-based
medicine, evidence-based management and evidence-informed
policy making approaches and social prescribing. The restraining
factors for balancing overuse and underuse were conflict of
interest issues, payment systems, paternalism and medicalization,
patients and physicians’ side problems and culture of consumerism
in the community. The total scores for and against change were 14
and 17, respectively.
CONCLUSION: It seems that the emphasis on education and
training in this field is essential for physicians, patients and all
people in the community. Also, making reforms in payment systems
and changing the rules and regulations in this area could be major
KEYWORDS: Overuse,

Published: 2019-05-28