Looking for value in health care

Faced with limited resources, health care systems are obliged to identify low-value interventions that should not be funded

Ineffective or harmful clinical interventions and services are of no value to patients and waste limited health care resources. About 30% of United States health care expenditure reflects health services of uncertain value.1 More than half of established practice standards, when formally evaluated for effectiveness compared with alternatives, are found to be either less effective or of questionable benefit.2 Even practices deemed effective in trials conducted decades ago have been shown to be ineffective in more recent studies.3 Public and private payers, professional bodies and government agencies are now engaged in identifying “low-value” practices that should no longer be funded.4 The challenge in this is to develop evidence-based, transparent methods for undertaking this process, that are sensitive to the needs and concerns of patients and clinicians.