KYLIE WOOLCOCK Chief Executive AHHA
Reducing low-value care Waste within the healthcare system has been
of clinical quality registries and data analyses have
identified as substantial.. In the United States, for
made substantial advances in this direction.
example, reports have shown that between 21
However, despite enthusiasm for such initiatives,
and 47% of national health expenditure is wasted
few large-scale changes in the rates of low-value
each year. Other estimates suggest that only 60%
care have been reported.
of health care
‘De-implementation’ is an emerging area of
is delivered in line with guidelines, while 30% is
research. Around the world there has been a
waste, duplication or of low value. The final 10%
focus on de-implementation frameworks, such
is care that leads to harm. The landmark
as Canada’s Choosing Wisely De-implementation
Australian Care Track study explored how this
Framework, which emphasises focusing on local
waste varied according to different healthcare
priorities. In contrast, the Research Consortium for
encounters, with appropriate care estimated to
Health Care Value Assessment in the US proposes
occur in only 13% of encounters for alcohol
prioritising low hanging fruit.
dependence services through to 90% of encounters
Insights into barriers and facilitators are
for coronary
important in the quest for de-implementation.
artery disease.
Research in the Netherlands identified the most
Removing low-value care has broad ranging
important barriers to reducing the overuse of care
benefits. It positively impacts patient outcomes
were a lack of time, an inability to reassure the
and experiences, the financial sustainability of
patient, a desire to meet the patient’s wishes,
our health system, our environmental footprint,
financial considerations and a discomfort with
and the job satisfaction of our healthcare
uncertainty. The most important facilitators were
workforce.
support among clinicians, knowledge of the harms
There has been significant investment in Australia in identifying low or no-value care. Initiatives like Wiser Healthcare, the Australian Atlas of Healthcare Variation, Evolve, Choosing Wisely, the MBS Review, Prostheses List reforms, and the use
of low-value care and a growing consciousness that more is not always better.
