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Public Puzzled About Value in Health Care But Open to Change, Study Finds

March 23, 2017

The high cost of health care is a familiar topic in the national dialogue, but there are major gaps in the public’s understanding of the role low-value medical care plays in driving up health care expenses, a new study by the Yale School of Public Health finds.

The public’s view of low-value medical care, such as costly procedures and tests with questionable therapeutic value, cuts across race, ethnicity and social status. These disparities could be at least partially reduced with consistent media messages that spotlight the health threats associated with excess testing and the benefits of more personalized health care.

Mark J. Schlesinger, Ph.D., professor in the Department Health Policy and Management, and a colleague used focus groups, intensive interviews and surveys to reveal that despite the low yield of procedures such as unnecessary screenings and antibiotics, one third of Americans have difficulty imagining the benefits of reducing low-value health care. That figure increases to half for patients who are less educated or from underserved groups. The Institutes of Medicine has determined that as much as 30 percent of health care in the United States can be defined as low-value, contributing to $765 billion in unnecessary health care expenditures in 2013 alone.

The study also revealed several surprising findings. Although two-thirds of people surveyed favored more conservative clinical care, which would eschew particular low-value treatments, many fewer were willing to choose a physician who practiced conservatively. Less than half the respondents would hypothetically opt for a clinician who would favor selective treatment and watchful waiting, and 35 percent to 40 percent favored clinicians in real life who were below average in ordering frequently overused tests and treatment.

“Despite frequent claims that patients are the primary cause for unnecessary tests and treatments, most people are willing to watchfully wait for many conditions where low-value is common. Yet many of these same patients are not yet ready to choose a doctor based on metrics about low-value care given to other patients,” said Schlesinger.

Our findings suggest that public education campaigns can do better.

Mark Schlesinger

In another twist, there is still a sizable group of patients, about one in five according to the findings, who continue to favor more aggressive treatment and practitioners. This portion of the public has a hard time even imagining any benefits that might come from reducing the amount of low-value care.

To debunk the opinion that “more is better” when it comes to health care, the study suggests that public education is vital to reducing spending, with an emphasis on the great risks and limited rewards of low-value procedures. A particularly promising way to do this, the study suggests, is to demonstrate to the public how excessive testing can be replaced with the promise of more personalized medicine–which gives clinicians more time to talk to patients and listen to their needs.

“Our findings suggest that public education campaigns can do better,” Schlesinger said. “ By reframing the ways in which low-value care is understood by the public, these initiatives can motivate broader consumer activism and likely diminish ethnic and racial disparities in recognition of this issue.”

Rachel Grob, Ph.D., a senior scientist in the Department of Family Medicine and an associate clinical professor at the Center for Patient Partnerships at the University of Wisconsin Law School, coauthored the study. The paper is published in The Milbank Quarterly.

Submitted by Denise Meyer on March 23, 2017