Effectively addressing lowâvalue care calls for engaging the public, including the oneâthird of Americans who currently cannot envision benefits from avoiding lowâvalue care.
Public awareness of and response to lowâvalue care can be enhanced through revised media messaging. These efforts are more effective if they emphasize health risks rather than the financial costs associated with unnecessary tests and treatments.
Longâterm robust public support for addressing lowâvalue care may require shifting the focus from particular tests and treatments to emphasize, instead, the potential for better communication and more personalized attention if clinicians spend more time talking and less time testing.
Context
As much as 30% of US health care spending may be unnecessary. The Choosing Wisely campaign, now active in a dozen countries, addresses this problem in part through public education campaigns. This article explores Americansâ understanding of lowâvalue care in 2015, assesses the impact of media messaging, and tests alternative message framing.
Methods
We use a mixedâmethods design incorporating (1) 8 focus groups exploring Americansâ understanding of and language for lowâvalue care, (2) 48 intensive interviews with patients on their interactions with physicians regarding questions of cost and value, (3) a national survey of 920 respondents examining their awareness of lowâvalue care, and (4) a survey experiment with 785 participants, testing the impact of media messages on attitudes about lowâvalue care, treatment choices, and selection of a primary care clinician.
Findings
Oneâthird of Americans have difficulty envisioning benefits from avoiding lowâvalue care, a figure that increases to half for less educated and minority respondents. Most Americans who anticipate benefits hope that less testing and treatment will be replaced by more interactive and personalized care. Even without media priming, many Americans would avoid common forms of lowâvalue care like unnecessary antibiotics or excess imaging for lower back pain, but few favor clinicians who avoid these practices. Although the public's awareness and actions are increased and disparities are reduced by media messaging, conventional messages also exacerbate the blame placed on providers. Avoiding lowâvalue care is enhanced, blaming providers is reduced, and disparities are further diminished if messages put more emphasis on the health risks of these tests and treatments.
Conclusions
The public's awareness of lowâvalue care is incomplete, with substantial disparities related to race, ethnicity, and socioeconomic status. Media messaging can help fill these gaps but, in the short run, would be enhanced by fineâtuning how lowâvalue care is characterized. In the longer run, building robust public support for reducing lowâvalue care may require refocusing attention away from specific tests and treatments and toward the relational benefits for patients if clinicians spent less time on testing and more time on personalized care.