Cutting back on low-value health care practices supports sustainable kidney care

Abstract

July 2023 marked the hottest month on record, underscoring the urgent need for action on climate change. The imperative to reduce carbon emissions extends to all sectors including healthcare, with it being responsible for 5.5% of global emissions. In decarbonising healthcare, while much attention has focused on greening healthcare infrastructure and procurement, less attention has focused on reducing emissions through demand-side management. An important key element of this is reducing low-value care, given that approximately 20% of global healthcare expenditure is considered low-value.“Value” in healthcare, however, is subjective and dependent on how health outcomes are regarded. This review therefore examines the three main value perspectives specific to healthcare. Clinical effectiveness defines low-value care as interventions that offer little to no benefit, or have a risk of harm exceeding benefits. Cost-effectiveness compares health outcomes versus costs compared to an alternative treatment. In this case, low-value care is care greater than a societal willingness to pay for an additional unit of health (QALY). Lastly, community perspectives emphasize the value of shared decision-making and patient-centered care.These values sit within broader societal values of ethics and equity. Any reduction in low-value care should therefore also consider patient autonomy, societal value perspectives and opportunity costs, and equity. De-implementing entrenched low-value care practices without unnecessarily compromising ethics and equity will require tailored strategies, education, and transparency.