• “Over 150 potentially low-value health care practices”

    A total of 5209 articles were screened for eligibility, resulting in 156 potentially ineffective and/or unsafe services being identified for consideration. The list includes examples where practice optimisation (ie, assessing relative value of a service against comparators) might be required.

    The list of health care services produced provides a launchpad for expert clinical detailing. Exploring the dimensions of how, and under what circumstances, the appropriateness of certain services has fallen into question, will allow prioritisation within health technology reassessment initiatives.

    The article is here, and the list is in an appendix. All entries are sourced. Not all of them are of zero value for all people, but all are of low to no value to some to whom they are provided. A straightforward and useful research project would be to estimate U.S. expenditure for each service, possibly stratified by payer (Medicare, commercial market, etc.). One could also contemplate geographic variation.


    • The paper itself says: “Most often, a service shows differential effectiveness profiles, dependent on the characteristics of the population in whom it is applied.”

      Many of the items listed still have significant value to individual patients.

    • All of them generate revenue so the incentives are biased to keep doing them.
      Hard to fix this FFS boondoogle.

    • I think of the service side of healthcare spending as an analog of the bacterial colonization of a lab dish, the money that flows into the system as the growth media, the agar that feeds the growth. The notion that one will reduce health spending by eliminating ‘low value’ procedures seems to me the conceptual equivalent of thinking that the velocity of bacterial colonization on growth media can be moderated by selecting among efficacious and non-efficacious strains. Maybe, a little, but there’s still all that media, with all of the opportunity for growth that it represents, and nature, as they say, abhors a vacuum. Wouldn’t it be ever so much simpler to just limit the amount of growth media available for colonization? And isn’t it something of a fool’s errand to try to do anything else?