Overview of the Drivers of Low-Value Care Comment on "Key Factors that Promote Low-Value Care: Views of Experts From the United States, Canada, and the Netherlands".

Joshua R Zadro,Christopher G Maher

doi:10.34172/ijhpm.2022.6833

Abstract

Verkerk and colleagues explored the key drivers of low-value care from the perspective of 18 policy-makers and researchers who had led and evaluated at least one initiative to reduce low-value care or had been responsible for reducing low-value care in an organisation. They identified several drivers of low-value care presented in the 2017 Lancet Right Care Series (eg, fee for service payment systems, the pharmaceutical and medical device industry, fear of malpractice litigation, issues with research conduct and reporting, a culture of 'more is better' and 'new technology is better') but did not discuss some other important ones. In this commentary, we aim to extend the work of Verkerk and colleagues and provide some additional perspectives on the drivers of low-value care within the following categories: Economic incentives; Money, finance, and organisation; Knowledge beliefs, assumptions, bias and uncertainty; and Power and human relationships.

Highlights

By largely focusing on national-level factors that promote low-value care, the participants in Verkerk and colleagues study[1] missed some key drivers of low-value care related to knowledge, beliefs, assumptions, bias, and uncertainty.[4]
Knowledge Beliefs, Assumptions, Bias and Uncertainty: Flawed Production and Dissemination of Knowledge, Thinking Frameworks That Influence Decision-Making, Heuristics That Shape Thinking Frameworks, Common Assumptions of Modern Medical Culture, Dominance of the Biomedical Model, the Isolated Clinical Relationship The participants in Verkerk and colleagues study[1] identified that publication bias, the ambition of researchers, and industry-sponsored research can lead to research findings that overestimate the benefits of tests and treatments and mislead clinicians
New research often fails to reach those at the coalface and influence practice, while inaccurate online information misleads the public and encourages patients to request low-value care.[9,10]

Summary

Introduction

By largely focusing on national-level factors that promote low-value care, the participants in Verkerk and colleagues study[1] missed some key drivers of low-value care related to knowledge, beliefs, assumptions, bias, and uncertainty.[4]. Knowledge Beliefs, Assumptions, Bias and Uncertainty: Flawed Production and Dissemination of Knowledge, Thinking Frameworks That Influence Decision-Making, Heuristics That Shape Thinking Frameworks, Common Assumptions of Modern Medical Culture, Dominance of the Biomedical Model, the Isolated Clinical Relationship The participants in Verkerk and colleagues study[1] identified that publication bias, the ambition of researchers, and industry-sponsored research can lead to research findings that overestimate the benefits of tests and treatments and mislead clinicians.

Objectives

Results

Conclusion