Low-value care describes services, treatments, and tests that provide minimal, if any, clinical benefit to a patient’s health outcomes. The use of low-value care is medically questionable and results in the substantial misdirection of resources within the healthcare system. Understanding this concept is important for improving the effectiveness of care and the financial sustainability of health services.
Defining the Criteria for Low Value Care
Low-value care is categorized based on professional criteria that go beyond simply labeling a service as unnecessary. The first characteristic is a lack of demonstrated efficacy, meaning the service does not improve health outcomes or provide a measurable clinical benefit. If a treatment fails to offer a meaningful advantage over doing nothing or a less intensive approach, it is considered low value.
A second criterion is the potential for harm to outweigh any possible benefit. Even if a procedure offers a theoretical benefit, the risk of complications, side effects, or injury can render it low value. This risk is unacceptable when the expected return is minimal.
The third standard involves the availability of safer, cheaper, or equally effective alternatives. For instance, if an expensive new procedure does not outperform an established, low-cost generic option, the newer service is generally considered low value. These three elements—minimal clinical benefit, disproportionate harm, and superior alternatives—help health systems determine what constitutes low-value care.
Specific Examples of Low Value Services
One frequently cited instance is the routine use of advanced diagnostic imaging, such as CT scans or MRIs, for patients with uncomplicated low back pain. For patients without “red flag” symptoms like fever, trauma, or neurological deficits, imaging within the first six weeks rarely changes the treatment plan. This practice exposes the patient to unnecessary radiation and cost.
Another common example involves aggressive cancer screening in older adults with limited life expectancy. For men over 75, the U.S. Preventive Services Task Force (USPSTF) recommends against routine prostate-specific antigen (PSA) testing because the risk of overdiagnosis and resulting unnecessary biopsies or treatments far exceeds the negligible chance of extending life.
Similarly, ordering extensive laboratory tests, like a complete blood count or metabolic panel, for a low-risk patient before a low-risk surgical procedure is often considered low value. These tests rarely detect an issue that would change the course of the surgery, yet they incur costs and can lead to false-positive results. False-positives often trigger a cascade of additional, invasive follow-up testing and specialist referrals, representing poor resource allocation and avoidable risk.
Factors That Drive Low Value Care
Several intertwined systemic and behavioral factors help explain why low-value care remains prevalent in healthcare. A major driver is the fee-for-service payment model, which financially rewards providers for the volume of services they deliver, rather than the value or quality of care. This payment structure creates an incentive to perform more tests and procedures, even if the marginal benefit is small or non-existent.
The practice of defensive medicine also contributes. Providers may order unnecessary tests or scans primarily to shield themselves from potential malpractice lawsuits. The provider’s concern is to show they were thorough, even if the clinical guidelines do not support the diagnostic step. This fear of litigation encourages a culture of “more is better.”
Patient demand is another important factor, often fueled by personal anxiety or misinformation from non-expert sources. Patients may specifically request a certain test, like an MRI for a minor headache or an antibiotic for a viral infection. Clinicians may feel pressured to comply with these requests to maintain patient satisfaction, even when the requested service is medically unwarranted.
The Consequences of Unnecessary Care
The continued use of low-value care generates negative impacts that extend into both financial and direct patient harm. The financial burden is substantial, as low-value care is estimated to waste hundreds of billions of dollars annually in the United States alone. This wasted spending contributes directly to higher healthcare premiums, increased deductibles, and greater out-of-pocket costs for the average person.
The diversion of resources to low-value services limits the funds available for truly high-value interventions, hindering broader healthcare system sustainability. Beyond the financial strain, patients face direct medical consequences, including complications from unnecessary procedures, such as infections or bleeding. Unwarranted testing also exposes patients to radiation from imaging and the anxiety associated with false-positive results.
These false-positives lead to a cascade of further invasive follow-up tests, which carry their own risks and emotional stress for the patient. Recognizing these consequences, organized efforts like the Choosing Wisely campaign have been launched to educate both patients and providers about specific low-value services to be questioned. This movement reinforces the need to mitigate the impacts of unnecessary care by prioritizing evidence-based practices.