OHSU investigators uncover factors driving “low-value care”

Waste accounts for roughly 20 percent of spending in the U.S. health care system. A significant portion of that waste is attributed to low-value care – unnecessary tests and treatments that are not only costly but provide little clinical benefit or may even harm patients. However, little was known about the patterns and drivers of this type of care. In a first-of-its kind study, researchers from OHSU’s Center for Health Systems Effectiveness (CHSE), compared low-value care among more than 1.6 million Medicaid and commercially insured patients in Oregon. They found no association between insurance type and low-value care, with Medicaid patients more likely to receive some low-value services but less likely to receive others.

Commercial reimbursement rates are generally much higher than Medicaid rates, so co-authors of this study, Christina Charlesworth, M.P.H., research associate, and John McConnell, Ph.D, associate professor in the School of Medicine’s Emergency Medicine Department and CHSE director, were a “little surprised” to find no consistent association between insurance type and low-value care.  They did find an association between low-value services and geographical practice areas, indicating this care may be more closely related to local norms or access to equipment than to reimbursement generosity or insurance benefit structures. Results of this study, published in JAMA Internal Medicine, provide key information for the medical community, policy makers, and patients in their efforts to improve value in health care.