6.Y.1. Defining, measuring, and reducing low-value care in Europe - proposing a new definition and framework
Authors:   Organised by: European Observatory on Health Systems and Policies, EU Expert Group on Health Systems Performance Assessment,   Chair persons: Dimitra Panteli (Belgium), Kenneth Grech (Malta)
Published: October 2024

Abstract

The EU Expert Group on Health Systems Performance Assessment (HSPA) selected value-based healthcare, with a focus on low-value care, as the work topic for 2023-2024. Against the backdrop of increasing healthcare expenditures and the overall aim to deliver high quality and efficient healthcare, efforts to reduce waste and inefficiencies have long been emerging in health systems worldwide. Value-based healthcare shifts the focus towards improving patient outcomes; the concept of low-value care in particular aims to identify health services that provide little or no health benefits but expose patients to potential harm. The COVID-19 pandemic clearly demonstrated that value-based healthcare is a prerequisite for high-performing health systems and the need to steer resource allocation to those services that maintain or improve health. The reduction in certain elective services observed during the pandemic (e.g. tonsillectomies) indicates that there may be areas for potential dis-investment and reallocation of resources to higher-value care. The pandemic has thereby emphasized the need for identifying and systematizing measurable efforts directed at reducing low-value care. Tackling low-value care can contribute to alleviating health workforce constraints by ensuring that efforts are focused where they are most beneficial, and not on unnecessary services. Engaging and educating the health workforce about low-value care and how to reduce it is a key measure in this direction. What is more, there is increasing awareness about the health sector’s considerable environmental footprint. Reducing low-value care would contribute to less greenhouse gas emissions, energy consumption and air pollution from the delivery of health services. Despite intensified efforts to address waste and inefficiencies in healthcare in the last decade, the ability of health systems in Europe to identify and reduce low-value care varies. Through the Expert Group’s work, a new comprehensive definition was proposed and a framework to distinguish different types of low-value care was developed as a basis for identifying and tackling low-value care in EU Member States. Indicators to measure low-value care as well as measures to reduce it were collected. This workshop aims to present the findings of the Expert Group´s work on low-value care and to discuss them with conference participants to both raise awareness and identify priority elements for future activities. After a brief introduction on the definition, framework, obstacles and solutions, the panelists will share their views and experiences, followed by a facilitated discussion with the audience.

Key messages
• A comprehensive definition of low-value care and an accompanying framework for categorizing and identifying low-value care is proposed.
• Country experiences with indicators to measure low-value care and strategies to reduce it, as well as related methodological obstacles, offer substantial opportunities for cross-country learning.