Despite Americans’ Support for Avoiding Low-Value Health Care, One-Third Have Difficulty Understanding Benefits of Conservative Approaches; Few Favor Doctors Who Avoid Unnecessary Care

“Low-value care” is defined as expensive procedures and tests with questionable therapeutic value; examples include unnecessary screenings and antibiotics.

As much as 30% of U.S. health care spending may be unnecessary. However, one-third of Americans “have difficulty envisioning benefits from avoiding low-value care,” according to a study published in The Milbank Quarterly. This figure increases to one-half for minorities and those who are less educated.

“The public’s awareness of low-value care is incomplete, with substantial disparities related to race, ethnicity, and socioeconomic status,” the study finds. “Media messaging can help fill these gaps but, in the short run, would be enhanced by fine-tuning how low-value care is characterized. In the longer run, building robust public support for reducing low-value care may require refocusing attention away from specific tests and treatments and toward the relational benefits for patients if clinicians spent less time on testing and more time on personalized care.”

The research, conducted by Mark Schlesinger, Yale School of Public Health, and Rachel Grob, University of Wisconsin-Madison, involved a range of methods, including focus groups, intensive interviews with patients and a national survey.

Less time on low-value care means more time on personal care, right? Not so fast…

Specifically, the respondents anticipated two distinct changes: they “expected that spending less time ordering and reading tests would allow clinicians more time to talk with their patients” and that “taking a more mindful, less routinized approach to testing would encourage discussion of the benefits and limitations of each approach and greater acknowledgment of clinical uncertainty,” the authors note.

“Most Americans who anticipate benefits hope that less testing and treatment will be replaced by more interactive and personalized care. Even without media priming, many Americans would avoid common forms of low-value care like unnecessary antibiotics or excess imaging for lower back pain,” the authors say. However, “few favor clinicians who avoid these practices.”

For example, “many patients now seek specific tests or procedures or insist on quick interventions because they feel the pressure of work and home responsibilities. Clinicians find such requests difficult to refuse, even when they recognize that acquiescing will have little clinical benefit.”

These findings demonstrate that even though we are wasting nearly one-third of our health care dollars, people still are not sure they want to actively not choose “low-value care.”

Interestingly, we have seen this dynamic before (see our recent blog on “Breast Cancer: Less is More, Says Surgical Chief”); it is difficult to convince physicians and patients both that less is more.

What can we do to address this disconnect? Educating the public is a good place to start, as the authors recommend.

“To debunk the opinion that ‘more is better’ when it comes to health care, the study suggests that public education is vital to reducing spending, with an emphasis on the great risks and limited rewards of low-value procedures,” as the Association of Schools & Programs of Public Health (ASPPH) says.

But how we message this matters, the study authors emphasize: In order to maximize public education efforts on low-value care, the messages, and resulting media coverage, “must be adapted to resonate as strongly as possible with the public’s values, perceptions, and preferences about medical care,” they say.

We need to start explaining what low-value care even means. “What is needed is a message campaign that has the capacity to reach, and mobilize, the majority of Americans who currently see no advantage in reducing low-value care, particularly the third of the population that has little current understanding of what that concept even means or why it matters.”