Reducing the Tendency for Over- and Under-Provision of Health Services at the Point of Care: The Roles of Evidence-Based Medical Education and the Patient-Centered Clinical Method

抄録

In order to reduce ever-increasing social security expenditure, the Government of Japan is attempting to improve the efficiency of healthcare services. The premise of these efforts is that there exists a high degree of waste in the present system. However, the problem lies not only in over-provision of health care, but also extends to under-provision. To redress over- and under- provision of healthcare services and promote the right care, it is necessary to gain the awareness of and secure action from healthcare providers, users, and government officials. Because this is an area that involves human cognition and the modification of behavior, it is not a simple task. However, many other countries have been tackling this problem of low-value care through trial and error. Three forces that govern the de-adoption of low-value care have been previously described: evidence that a current practice provides little or no value, eminence that comes from professional societies issuing practice guidelines or recommendations against a low-value service, and economics (financial incentives) that can be used to catalyze de-adoption. In addition, education for primary health care professionals is important to enable them to fully understand the patient-centered clinical method and to implement it within their healthcare practice by taking users’ emotions and the cost-effectiveness of care into consideration. By following the examples of other countries’ efforts to reduce over- and under-provision in their respective healthcare systems, considerable fiscal benefits can be expected in Japan. This paper revisits the definitions of medical screening, examines over- and under- provision of health care by taking lung cancer screening as an example, introduces overseas attempts to de-adopt low-value care, and outlines the patient-centered clinical method.