The Disposable Dilemma: Waste in American Medicine

It’s an American nightmare. Patients are always receiving exorbitant bills with charges they never even heard of. Even after insurance, it’s hard to understand why these costs are so high. Behind this everyday occurrence lies a massive system of waste that few healthcare professionals fully comprehend, yet all contribute to sustaining.

The scale of this hidden economy is staggering. Recent analyses estimate that waste consumes between $760 billion and $935 billion annually, representing ~25% of total healthcare spending [1]. Exacerbating this cost is that healthcare waste operates largely invisible to public scrutiny.

Administrative Complexity

Administrative costs dominate the waste landscape. The United States gives $265.6 billion annually to administrative complexity [1]. Breaking this down shows how far behind America is lagging. We spend $1,055 per capita on healthcare administration, while Germany, the next highest spender, pays $306 per capita [2]. Multiple payers mean multiple billing systems, authorization protocols, and documentation requirements. Physicians sacrifice an estimated $68,000 worth of time annually working through red tape and insurance requirements  rather than treating patients [2].

Every dollar consumed by administrative excess represents care that is not delivered, a medication that is not purchased, or a screening that is not performed. Resources diverted to billing specialists and claims adjusters don't heal anyone. But the system perpetuates itself because those who add administrative burdens rarely have to bear the costs [2]. Insurers demand prior authorizations, so providers spend hours securing them. Device manufacturers label products single-use, so hospitals pay disposal fees while reusable alternatives gather dust.

Addressing healthcare waste requires confronting entrenched interests. Waste represents someone's income. Each relevant group will resist changes threatening their revenue. However, the ethical imperative remains because a system consuming 18% of GDP while leaving millions uninsured/underinsured cannot justify wasteful practices that serve provider convenience rather than patient benefit [1].

 Single-Use Devices

Walk through any American operating room and notice how much gets discarded after single use. It’s everywhere in this country.  Many of these items were reusable just decades ago. The shift accelerated in the late 1970s as manufacturers introduced plastic alternatives and marketed disposability as synonymous with sterility [3]. Somehow though, European hospitals safely reuse many items Americans discard. Studies from developing nations demonstrate that properly sterilized "single-use" devices perform comparably to new ones without increased infection rates [4].

The environmental and economic costs are huge. North America generated 1.2 million metric tons of single-use healthcare plastics in 2023, imposing costs up to $29 billion on health systems. Without intervention, plastic waste could surge 28% by 2040, pushing annual costs to $37 billion [5]. 

Several factors explain American reluctance to use reusables. Sterilization requires infrastructure like autoclaves, tracking systems, and specialized staff. Because they calculate costs differently than other nations, American hospitals often find disposables "cheaper" when labor expenses weigh heavily in the equation. Liability concerns also matter. Device manufacturers explicitly warn against reprocessing to protect themselves from lawsuits and shift risk to hospitals that choose reuse [6].

It is a difficult topic to resolve because patient safety is the most important goal. Inadequate sterilization does risk cross-contamination, but labeling everything "single-use" without rigorous evidence that reprocessing causes harm represents a different ethical failure. Banner Health saved $1.5 million annually reprocessing compression sleeves and pulse oximeters [7]. One health system saved $3.5 million over four years switching to reusable gowns while reducing environmental impact by 60% [8]. This proves that a significant sum of money can be saved through these efforts. 

An Ethical Perspective

Healthcare waste poses a justice problem as much as an efficiency problem. When preventable waste consumes 25% of spending, that money cannot serve other purposes: expanding coverage, improving access, funding prevention programs, addressing social determinants of health. The opportunity cost of waste falls disproportionately on vulnerable populations who lack insurance or face crushing medical debt. They subsidize administrative complexity they never requested and defensive practices that don't improve their outcomes. Maybe most fundamentally, waste erodes trust. When patients perceive the system as exploitative and designed to maximize revenue rather than health, their caregiver relationships suffer. 

The path forward seems clear even if it is politically difficult. Simplifying administration through standardization/consolidation, basing clinical decisions on real evidence, and evaluating single-use device designations critically all can help improve the current system. Those defending wasteful practices should demonstrate patient benefit, not provider convenience or profit potential. Healthcare resources remain precious and finite, and they should be used in service of healing rather than their squandering in service of a system that lost its way.

Reviewed by: Jiyu Hong

Designed by: Maziar Salartash

References: [1] Shrank, W. H., Rogstad, T. L., & Parekh, N. (2019). Waste in the US health care system: Estimated costs and potential for savings. JAMA, 322(15), 1501-1509.

[2] Sahni, N. R., Carrus, B., & Cutler, D. M. (2022). The role of administrative waste in excess US health spending. Health Affairs Brief.

[3] FDA (U.S. Food and Drug Administration). (2000). Reuse of single-use medical devices. Retrieved from https://www.govinfo.gov/content/pkg/CHRG-106hhrg62970/html/CHRG-106hhrg62970.htm

[4] Krairiksh, M., & Blough, S. (2005). Reprocessing and reuse of single-use medical devices used in developing countries. International Journal of Infection Control, 1(2).

[5] MacNeill, A. J., McGain, F., & Sherman, J. D. (2024). Planetary health impacts of single-use plastics in health care: A quantification of greenhouse gas emissions and alternative strategies. The Lancet Planetary Health, 8(1), e45-e54.

[6] Health Canada. (2023). Reprocessed single-use semicritical and critical medical devices. National Collaborating Centre for Methods and Tools.

[7] Unger, S., & Landry, A. (2020). Reprocessing and reuse of single-use medical devices and the role of interprofessional collaboration: A literature review. Journal of Multidisciplinary Healthcare, 13, 403-409.

[8] NHS England. (2022). Delivering a net zero National Health Service.