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Swimming Against the Current—What Might Work to Reduce Low-Value Care?

Doctor patient healthcare


As much as one-third of U.S. health care spending goes toward unnecessary or “low value” care, for which the costs outweigh the potential benefits. Efforts to reduce use of low-value care have met with resistance from providers and patients, but that is now changing as businesses, government, and individuals face rising health care costs.

Evaluating Interventions to Reduce Low-Value Care

In a New England Journal of Medicine Perspective, Carrie H. Colla of the Dartmouth Institute for Health Policy and Clinical Practice discusses the pros and cons of financial and educational interventions targeting patients and providers. While most approaches show some potential for lowering overuse, they also have significant drawbacks, Colla finds. For example, financial incentives, such as cost-sharing for patients or pay-for-performance for providers, may reduce use of effective as well as ineffective or unneeded care. Moreover, the same service may be low value in some situations and high in others, making measurement difficult.

Following evidence-based guidelines also can promote high-value care, but there are few studies showing that this is effective in reducing low-value care. Programs that identify low-value services and develop educational materials to help patients make informed decisions show promise, but current culture and payment models do not support their widespread development and use.


Population-based, provider-focused incentives combined with efforts to monitor outcomes may hold the greatest potential to encourage clinicians to deliver efficient and effective care, the author says. This approach will require investments in the development of patient decision aids, clinical decision support, and clinician education and feedback.

Publication Details



Carrie H. Colla, Assistant Professor, Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School

[email protected]


C. H. Colla, “Swimming Against the Current—What Might Work to Reduce Low-Value Care?” New England Journal of Medicine, Oct. 2, 2014 371(14):1280–83.