The Choosing Wisely campaign is “an important first step,” but just identifying low-value procedures is not enough to change doctors’ and patients’ behavior, according to a commentary on the campaign, published in the Journal of the American Medical Association.
The authors, three medical economists, suggest that a next step might be to adjust insurance terms to favor useful services and make patients pay more out of pocket for less-useful ones.
But this won’t solve the problem of patients relying for advice on physicians who may be ill-informed themselves or have a financial conflict of interest, they say.
And while national cost-benefit guidelines are “urgently needed,” the very agencies that could do those studies are by law prohibited from doing so.
So what to do?
The next step is to move beyond a list of low-value services toward the testing of approaches to reduce their use, ideally through a combination of benefit design, physician payment policies, and social and professional guidance informed by clinical evidence.