Optimizing Low-Value Health Care Services

Low-value health care services are those that confer little or no benefit to patients, may cause harm and contribute to the inefficient use of limited resources. Such services span diagnostic tests, imaging procedures, medications and routine interventions whose routine application is unsupported by robust evidence or misaligned with patient preferences. Worldwide, estimates suggest that 10–30 per cent of health care expenditure may be consumed by low-value practices. Drivers include fear of litigation, financial incentives, patient demand and fragmented information systems. Optimising low-value care requires systematic identification of overused practices, engagement of stakeholders, adaptation of service delivery and integration of decision support tools. Central strategies involve de-implementation—actively reducing or stopping entrenched but ineffective interventions—and the tailoring of policies and workflows to local contexts. Success hinges on multidisciplinary collaboration, robust monitoring of service use, feedback mechanisms for clinicians and patients, and alignment of incentives with evidence-based care. Real-world examples include limiting routine preoperative testing in low-risk surgery, reducing repeated imaging for uncomplicated back pain and curbing unnecessary antibiotic prescriptions in viral illnesses. When effectively deployed, optimisation not only improves patient safety and experience but also generates savings that can be reinvested in high-value services and innovation.

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Optimizing Low-Value Health Care Services publication trend

The graph below shows the total number of articles in optimizing low-value health care services across all publications each year (not limited to Nature Index journals).

Technical terms

Low-value care: A service whose costs, risks or harms outweigh any likely clinical benefit.
De-implementation: Structured efforts to reduce or discontinue use of established but unsupported health-care practices.
Multi-component intervention: A coordinated programme that combines two or more strategies (for example, education, guidelines and workflow redesign) to change clinical behaviour.
Stakeholder interrelationships: Collaborative networks among clinicians, patients, administrators and policymakers that support coherent change processes.

References

1. Effectiveness of de-implementation of low-value healthcare practices: an overview of systematic reviews. Implementation Science (2024).
2. Limit, lean or listen? A typology of low-value care that gives direction in de-implementation. International Journal for Quality in Health Care (2018).
3. Interventions to reduce low-value imaging – a systematic review of interventions and outcomes. BMC Health Services Research (2021).
4. Determinants for the use and de-implementation of low-value care in health care: a scoping review. Implementation Science Communications (2021).