Overview of the Drivers of Low-Value Care; Comment on “Key Factors that Promote Low-Value Care: Views of Experts From the United States, Canada, and the Netherlands”

Document Type : Commentary


1 Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia

2 Sydney Local Health District, Sydney, NSW, Australia


Verkerk and colleagues explored the key drivers of low-value care from the perspective of 18 policy-makers and researchers who had led and evaluated at least one initiative to reduce low-value care or had been responsible for reducing low-value care in an organisation. They identified several drivers of low-value care presented in the 2017 Lancet Right Care Series (eg, fee for service payment systems, the pharmaceutical and medical device industry, fear of malpractice litigation, issues with research conduct and reporting, a culture of ‘more is better’ and ‘new technology is better’) but did not discuss some other important ones. In this commentary, we aim to extend the work of Verkerk and colleagues and provide some additional perspectives on the drivers of low-value care within the following categories: Economic incentives; Money, finance, and organisation; Knowledge beliefs, assumptions, bias and uncertainty; and Power and human relationships.


  • epublished Author Accepted Version: January 29, 2022
  • epublished Final Version: February 14, 2022
  1. Verkerk EW, Van Dulmen SA, Born K, Gupta R, Westert GP, Kool RB. Key factors that promote low-value care: views of experts from the United States, Canada, and the Netherlands. Int J Health Policy Manag. 2021. doi:34172/ijhpm.2021.53
  2. Brownlee S, Chalkidou K, Doust J, et al. Evidence for overuse of medical services around the world. Lancet. 2017;390(10090):156-168. doi:1016/s0140-6736(16)32585-5
  3. Glasziou P, Straus S, Brownlee S, et al. Evidence for underuse of effective medical services around the world. Lancet. 2017;390(10090):169-177. doi:1016/s0140-6736(16)30946-1
  4. Saini V, Garcia-Armesto S, Klemperer D, et al. Drivers of poor medical care. Lancet. 2017;390(10090):178-190. doi:1016/s0140-6736(16)30947-3
  5. Elshaug AG, Rosenthal MB, Lavis JN, et al. Levers for addressing medical underuse and overuse: achieving high-value health care. Lancet. 2017;390(10090):191-202. doi:1016/s0140-6736(16)32586-7
  6. Or Z. Implementation of DRG Payment in France: issues and recent developments. Health Policy. 2014;117(2):146-150. doi:1016/j.healthpol.2014.05.006
  7. Elshaug AG. Over 150 potentially low-value health care practices: an Australian study. Med J Aust. 2013;198(2):85. doi:5694/mja12.11770
  8. Medical Benefits Reviews Task Group. Development of a Quality Framework for the Medicare Benefits Schedule. Discussion Paper. Canberra: Australian Government Department of Health and Ageing; 2010. https://www1.health.gov.au/internet/main/publishing.nsf/Content/MBS_Quality_Framework. Accessed October 5, 2021.
  9. Robertson A, Birch M, Harris IA, et al. Online information about the effectiveness of shoulder surgery is not based on the best available evidence: a content analysis. Arch Phys Med Rehabil. 2021;102(11):2141-2149.e2. doi:1016/j.apmr.2021.03.041
  10. Ferreira G, Traeger AC, Machado G, O'Keeffe M, Maher CG. Credibility, accuracy, and comprehensiveness of internet-based information about low back pain: a systematic review. J Med Internet Res. 2019;21(5):e13357. doi:2196/13357
  11. Zadro J, Jones C, Harris I, et al. Development of a patient decision aid on subacromial decompression surgery and rotator cuff repair surgery: an international mixed-methods study. BMJ Open. 2021;11(8):e054032. doi:1136/bmjopen-2021-054032
  12. Stacey D, Légaré F, Col NF, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2014(1):CD001431. doi:1002/14651858.CD001431.pub4
  13. Zadro JR, Farey J, Harris IA, Maher CG. Do choosing wisely recommendations about low-value care target income-generating treatments provided by members? a content analysis of 1293 recommendations. BMC Health Serv Res. 2019;19(1):707. doi:1186/s12913-019-4576-1
  14. Moynihan RN, Cooke GP, Doust JA, Bero L, Hill S, Glasziou PP. Expanding disease definitions in guidelines and expert panel ties to industry: a cross-sectional study of common conditions in the United States. PLoS Med. 2013;10(8):e1001500. doi:1371/journal.pmed.1001500
  15. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Hypertension. 2018;71(6):1269-1324. doi:1161/hyp.0000000000000066
Volume 11, Issue 8
August 2022
Pages 1595-1598
  • Receive Date: 05 October 2021
  • Revise Date: 24 January 2022
  • Accept Date: 26 January 2022
  • First Publish Date: 29 January 2022