America Spend more on healthcare Higher than any other country and cost Rise faster than inflation a period of time. However, many policies to deal with rising costs ignore the elephant in the room: waste.It is estimated that waste accounts for about Quarter Of total U.S. healthcare expenditures.One of the main drivers of waste is low value Nursing is defined as providing care whose potential harm outweighs the potential benefit. It is estimated that 42% Beneficiaries of medical insurance, 15% Of Medicaid patients and 11% of commercial insurance patients (approximately 50 million people in total) experience one or more overuse incidents each year, with a wasted expenditure of US$106 billion.
But high costs are not the only consequence of the inefficiency and waste of services in the healthcare system.Overuse of low-value care can lead to Real harm For patients, take the form of unnecessary invasive surgery, unnecessary side effects, or leading to false positive test results A series of additional visits and treatmentsThe effects of these injuries are diverse: physical, psychological, social, and economic.
A unique opportunity to eliminate overuse can improve (or maintain) health outcomes and reduce expenditures, while reusing important resources to provide high-value care.More efforts need to be made to ensure that future health care reforms are not only about how much it is spent, but about How good All these funds have been spent. Identifying and understanding the drivers or determinants of overuse is essential to develop effective response strategies.
Some academic and research institutions have made significant progress in this regard.In the past few years, the Value Consortium has Development Framework Identify, measure, and ultimately reduce the prevalence of low-value care throughout the healthcare system. In doing so, the Value Alliance has also identified areas that need more research in the future to better understand the key drivers of low-value care.
The practical application of Consortium’s low-value care framework in the analysis of commercial insurance claims data has produced important insights about low-value care.These findings support that low-value care is Very common throughout the U.S. healthcare system, Affected by significant geographical differences And that Its underlying drivers are still not well understood.
Many of the findings of the alliance are consistent with my own research.exist Recent work, We found that regional differences in overuse persist over time, indicating that they are the result of systematic and local differences in care services, rather than random noise.US Also found There is a correlation between the observable structural characteristics of the regional health care system and overuse.Addressing low-value care needs purposeful Experiment and cooperation By many different stakeholders.
There are many opportunities to promote solutions in this area. First, it is clear that stronger evidence is needed to prove the clinical effectiveness of health services to determine the main source of low-value care.Although it only includes 14% Health care expenditures, About 43% The most recent cost-benefit analysis study evaluated drugs. At the same time, only 22% of recent studies involved medical and surgical interventions. Researchers and research funders should use investment in clinical and cost-benefit analysis and other forms of health technology assessment to identify and resolve low-value care in holistic care.
In terms of policy formulation, options for controlling low-value care and promoting high-value care as a whole have been proposed.Reducing low-value care may require both financial and Non-financial, behavioral and cultural drivers overuse. Some researchers have proposed the use of “screen doorA method that is conducive to design and payment systems that can prevent low-value care while allowing high-value services to “pass.” But the successful implementation of such a plan requires someone to reliably separate low-value and high-value services from each other while continuing Provide patients with appropriate levels of healthcare services.
A sort of System review Interventions found that those that address both the role of patients and clinicians in overuse are the most likely to reduce low-value care – as are methods such as clinical decision support, performance feedback, and provider education. You can also consider planned incentives for benchmarking or quality measures. Whichever method you choose, strong patient participation will be the key to ensuring that low-value care is properly defined, and tools are prepared to drive more patient and clinical participation to avoid the use of low-value care. It is also important to recognize that further research is needed to address the persistent gaps in the existing evidence.
Achieving a higher-value healthcare system will be the effort of multiple stakeholders. There is no single driver for low-value care—providers, systems, and patients all play a role. But with the right tools, researchers, policymakers, and industry stakeholders can work together to realign incentives and transform our healthcare delivery system into a system that prioritizes value, eliminates waste, and leads to a better whole The system of patient outcomes.
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