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In search of professional consensus in defining and reducing low-value care

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The costs and harms associated with systemic overdiagnosis and overtreatment are receiving international attention. Clinicians and their professional organisations are obliged to assume resource stewardship as an ethical responsibility as embodied in the 2002 millennium professional charter.

Low-value care is use of an intervention where evidence suggests it confers no or very little benefit on patients, or risk of harm exceeds likely benefit, or, more broadly, the added costs of the intervention do not provide proportional added benefits. The lattermost concept involves considering benefit and cost relative to those of alternative care options, as embodied in cost-effectiveness analysis.1 Examples of high-value and low-value care occupy a matrix which emphasises this relativity of benefit over cost (Appendix 1). Care may be high (or low) value if, despite higher (or lower) costs, it confers proportionately greater (or lower) benefit. Choosing low-value care consumes resources that could have been expended on alternative forms of care conferring greater levels of benefit, either to the patient in question or to other patients.

Efforts to reduce low-value care run counter to the dominant financial incentives in our fee-for-service (private sector) and activity-based funding (public…