Recomendado pela AMICOR Maria Inês Reinert Azambuja
Carrie H. Colla, Ph.D.
- Article
Efforts to reduce overuse of health care services run counter to the dominant financial incentives in our fee-for-service system, challenge the cultural assumption that more is better, and raise concerns about stinting on necessary care. Given the evidence that as much as one third of U.S. health care spending is wasteful, however, health care organizations are now embracing explicit consideration of value and turning their attention to overuse. Reducing overuse could theoretically improve quality while slowing spending growth. But we need to determine whether current policy tools — which were designed to address underuse — will work to reduce overuse.
Public acceptance of a role for policy in reducing the use of low-value care in the United States is tenuous but increasing with growing awareness of the burden that health care spending places on federal and state budgets and with patients' increasing exposure to health care costs. Many policy levers might improve the value of care (see
table
Demand-Side and Supply-Side Interventions to Reduce Low-Value Care.), but all have their limitations. In recent years, the American Board of Internal Medicine Foundation's Choosing Wisely program, the U.S. Preventive Services Task Force, and the National Quality Forum have advanced the dialogue about low-value care by identifying services that deserve that label. Low-value care can be defined in terms of net benefit, a function of the expected (though uncertain) benefit and cost for an individual or group, and is assessed relative to alternatives, including no treatment. This labeling introduces the opportunity to target such care with tools aimed at reducing its use. So how can we effectively use policy to support physicians and patients in making appropriate decisions regarding low-value care?/.../
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