Underutilization in healthcare is not a new concept, but it is one that has not received as much attention as the related problem of overutilization. In a perfect world, “correct” utilization is similar to the concept of the “five rights” of medication use, which describe ensuring the right patient gets the right medication at the right time via the right route of administration and at the right dose. It is fairly straightforward to apply this framework of ensuring the right/correct parameters for medications to other forms of treatment and to testing. While this concept is philosophically correct from the perspective of practicing medicine, it ignores the realities of clinical practice, which include a physician’s understanding of when/how to proceed with a course of action, as well as the patient’s willingness or ability to engage in a physician’s recommendation. Of increasing importance, there are a variety of financial variables impacting whether such clinical care actually occurs. Unfortunately, the financial motivations of patients and physicians, particularly in the U.S., are significant enough to be drivers of health care utilization, independent of other factors affecting individual behavior.