A survey of the American public has identified low-value care as the root of billions of dollars of wasteful health care spending.
Researchers from the Yale School of Public Health and the Center for Patient Partnerships combined qualitative and quantitative methods of data collection to assess Americans’ relationship with the health care system at large, said Rachel Grob, director of national initiatives at the Center for Patient Partnerships and a co-author of the report. The study was published in the journal Milbank Quarterly on March 13.
In the first stage of the project, the researchers held focus groups and interviews to gauge public knowledge and opinion regarding low-value care before conducting a national survey.
Low-value health care is defined as services and medication that provide little to no substantial benefit, but it accounts for 765 billion dollars in annual health care spending and approximately 30 percent of all health care provided. This figure includes unnecessary tests and antibiotic prescriptions, which when used incorrectly can be harmful for the patient as well as wasteful for the economy, said Mark Schlesinger, a professor of health policy at the School of Public Health and a co-author of the report.
They found that for many patients, the perception that “more is better” in terms of care drives up demand for unnecessary testing and treatment. The classic example of excess treatment is patients who, under the impression that they have a bacterial infection, take antibiotics for a viral infection, according to Schlesinger.
“Our health care system is way more expensive than any other health care system in the world,” Schlesinger said. “And a big chunk of that is forms of testing and treatment that have very little benefit.”
“Typically when you get the flu, you have a cough for about three weeks,” he added. “If you just wait three weeks, the cough will go away, and you won’t need the antibiotics that weren’t doing anything anyway.”
Health care has been at the center of national debate in the U.S. for a number of years, with the conversation revolving around a variety of politically divisive topics such as health insurance. However, less attention has been paid to the more innocuous forms of waste in the system, including low-value care.
While large parts of the research focused on examining the problem, a fair amount of the work was dedicated to exploring possible solutions. Many of the questions Grob designed explore what exactly would convince the average health care consumer to stop viewing quantity of care as a measure of its value.
One solution, Schlesinger proposed, is to foster stronger doctor-patient relationships so that consumers know that they are receiving high quality care, even if they are not being subjected to excess tests and medication.
“Without a multi-stakeholder approach that engages every constituent, we can’t move towards a greater value health care system, or one where resources can be re-deployed to those who currently do not have access to coverage,” Grob said.
The paper drew attention to the Choosing Wisely campaign, a relatively new national initiative to reduce waste in the American health care system. The campaign encourages the participation of medical societies and hospitals.
The Connecticut branch of the Choosing Wisely campaign works with the Donaghue Foundation, a West Hartford-based nonprofit that connects researchers, health care providers and funders. Nancy Yedlin MED ’81, vice president of the Donaghue Foundation, has worked extensively on the implementation of the campaign in Connecticut and with the hospitals and doctors responsible for adhering to its guidelines.
“When the campaign first started, many groups didn’t embrace it or were afraid of it — they had all kinds of objections,” Yedlin said. “And from what I have seen, if you ask health systems now, many of them have moved toward trying to implement this campaign as part of a value-based strategy.”
It is often easier for doctors and health care providers to order tests and prescribe medication than to convince a patient that these measures are unnecessary, Schlesinger said. Historically, health care providers have profited from conducting tests and prescribing medication, which may have influenced their decisions regarding care, Yedlin said.
However, Yedlin added that the Connecticut Choosing Wisely Collaborative has engaged providers in a movement against reducing excessive spending. While the campaign is only three years old, Yedlin said she is confident that there have already been victories in the effort to reduce wasteful spending within the system.
In 2015, spending on health care in the U.S. reached $3.2 trillion.