Low-Value and No-Value Care in Healthcare: A Narrative Review

抄録

This narrative review summarizes the concepts of low- and no-value care (LNVC), the drivers behind them, and potential strategies for de-implementation, all with a particular focus on influential conceptual and empirical research. Low-value care (LVC) refers to healthcare services for which the costs outweigh the potential benefits, while no-value care (NVC) is a narrower definition that refers to healthcare services that provide no net clinical benefit for patients (regardless of the costs). A growing global body of research shows that LNVC is widespread and imposes substantial societal costs. Mitigating the provision of such care would reduce avoidable healthcare expenditures, improve the quality and safety of treatment by minimizing overdiagnosis and overtreatment, and improve overall health by reallocating resources to high-value care. LNVC arises from interrelated factors at the system, individual-provider, and consumer-demand levels, including system incentives, industry promotion, patient expectations, and physicians’ knowledge, habits, and fears. Despite increasingly intense efforts to address LNVC, several challenges persist in terms of identification, measurement, and intervention. Multicomponent interventions targeting healthcare providers have been shown to be effective at reducing LNVC from the supply side; such interventions may include recommendations from professional societies, quality metrics for LNVC, quality-improvement initiatives, clinical decision-support tools, and payment reforms (e.g., global budgets, prior authorizations, coverage policy). Given the uneven provision of LNVC, targeted strategies centered on high-volume providers could improve the efficiency of interventions. Importantly, eliminating NVC represents a clear and actionable starting point to facilitate coordinated, multi-level efforts and collaboration among a diverse range of stakeholders.