Researchers say a lot of low-value services such as lab tests and antibiotics aren’t expensive, but those costs add up over time.
In 2015, health expenditures in the United States
That accounted for nearly a fifth of the gross domestic product.
A sizable chunk of this spending is for low-value, unnecessary health services, according to a recent study.
Researchers noted that much of this low-value care is also low cost — but these costs do add up.
The study, headed by University of California Los Angeles (UCLA) researchers, was published in the October issue of Health Affairs.
“We still haven’t solved this problem, but understanding where the problem is happening and why it’s happening is going to be essential if we want to take control of this problem,” Dr. John Mafi, a lead author of the study and an assistant professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA, told Healthline.
Researchers looked at data on 5.5 million patients in the state of Virginia.
“Virginia actually got a grant for Medicare, an innovation grant, to look at wasteful healthcare using a waste calculator,” said Mafi. “The way this works is it looks at administrative claims data, and it collects data from all the health insurance companies and all the health insurance plans other than the VA hospital. That’s why it’s unique. Most datasets don’t have this complete of a picture. It’s pretty presentative of healthcare in Virginia.”
After analyzing the data, researchers concluded that services that provided no net health benefits to patients cost Virginia more than $586 million in 2014.
About 65 percent of that amount went to low-cost, high-volume services.
“We’ve known about this problem for decades, since the 1970s, really,” said Mafi. “Yet, overall health spending continues to grow, and unnecessary spending continues to remain at very high rates.”
Mafi defines low-value care as patient care where the chance of harm is greater than the chance of benefit.
Examples include unnecessary antibiotics for certain conditions and preoperative lab tests for low-risk surgeries.
To better identify specific examples of low-value care, researchers looked at 44 services that, according to evidence-based guidelines, constitute low-value healthcare.
In Virginia, it was found that one in every five beneficiaries received some sort of low-value care.
Most of the low-value care — accounting for two-thirds of low-value spending — came from inexpensive procedures.
“That was a big finding, and the implications of that are that we have a lot of low-hanging fruit to reduce unnecessary spending, and it suggests that maybe one more strategic way of tackling unnecessary or low-value care is going after these small potatoes,” said Mafi.
As for why there’s so much low-value care, there are multiple theories.
Among them are demanding patients who request a specific antibiotic or procedure, overworked doctors who have little time for in-depth consultations, and the fear of malpractice suits.
Unnecessary or low-value healthcare isn’t a problem that’s unique to the United States.
Mafi points out that systems where doctors are paid on a global budget, without rewards for doing extra services, is currently in place in Canada, the United Kingdom, and the Veterans Administration system in the United States.
But it doesn’t cut down on waste.
“When you look at low-value care, it’s just as much of a problem, proportionally, in the U.K. or VA or in Canada as it is in the United States,” Mafi said. “You might get lower amounts of care, but you’re still going to get waste. Waste is really hard to identify. It’s really more of a clinical nuance, so a broad financial incentive, or a broad policy, is unlikely to really specifically target the waste part with scalpel precision. It’s a really tough problem.”
To start eliminating low-value care without cutting healthcare budgets, Mafi promotes a ground-up approach.
“I think that the cold, hard truth is that nobody knows what the magic bullet is. I think what we really have to do is have health systems take the lead and promote experimentation. Be data-driven, results-driven. How to drive that from the policy perspective, other than making sure not to get in the way, is going to be tough,” he said.
Mafi’s research team plans to take a deeper dive into the existing data with follow-up studies.
They’ll look at the healthcare providers who provide the highest-value care with the lowest amounts of waste, and study what it is that makes them successful.
“What we don’t want to have happen is broad, draconian cuts of health spending across the board,” said Mafi. “That’s where you start to hurt people because you’re taking away lots of good things along with the bad. So don’t throw the baby out with the bathwater. Instead, let’s find ways to be clinically nuanced and get rid of unnecessary care specifically, as opposed to just getting rid of all care.”
To that end, Mafi says, it’s important that doctors and other health professionals be at the forefront of that effort.
“They’re the ones who understand the clinical nuance of where there’s waste, and the ways that something like an antibiotic can be low-value in one situation but high-value in another,” he said. “You want to keep that autonomy for doctors.”