Beyond Microsystem Fixes: Targeting National 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 Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

2 Division of General Internal Medicine, Sinai Health, Toronto, ON, Canada

3 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

4 Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, ON, Canada


Low-value care drivers and interventions are often focused on a microsystem (eg, clinic or inpatient ward) or within a health system. Identification of national drivers such as payment structure and medical culture of overuse can help identify regional approaches to reducing low-value care. However, these approaches in isolation are insufficient and require additional strategies. These can include policy and payment changes and adopting shared decision-making (SDM). SDM has the potential to move medical culture away from the ‘more is better’ paternalistic and physician-centric culture to one that actively engages patients as full partners in managing their care.


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Volume 11, Issue 9
September 2022
Pages 1971-1973
  • Receive Date: 12 January 2022
  • Revise Date: 12 July 2022
  • Accept Date: 19 July 2022
  • First Publish Date: 20 July 2022