Over 150 potentially low-value health care practices: an Australian study

Adam G Elshaug, Amber M Watt, Linda Mundy and Cameron D Willis
Med J Aust 2012; 197 (10): 556-560. || doi: 10.5694/mja12.11083


Objective: To develop and apply a novel method for scanning a range of sources to identify existing health care services (excluding pharmaceuticals) that have questionable benefit, and produce a list of services that warrant further investigation.

Design and setting: A multiplatform approach to identifying services listed on the Australian Medicare Benefits Schedule (MBS; fee-for-service) that comprised: (i) a broad search of peer-reviewed literature on the PubMed search platform; (ii) a targeted analysis of databases such as the Cochrane Library and National Institute for Health and Clinical Excellence (NICE) “do not do” recommendations; and (iii) opportunistic sampling, drawing on our previous and ongoing work in this area, and including nominations from clinical and non-clinical stakeholder groups.

Main outcome measures: Non-pharmaceutical, MBS-listed health care services that were flagged as potentially unsafe, ineffective or otherwise inappropriately applied.

Results: A total of 5209 articles were screened for eligibility, resulting in 156 potentially ineffective and/or unsafe services being identified for consideration. The list includes examples where practice optimisation (ie, assessing relative value of a service against comparators) might be required.

Conclusion: The list of health care services produced provides a launchpad for expert clinical detailing. Exploring the dimensions of how, and under what circumstances, the appropriateness of certain services has fallen into question, will allow prioritisation within health technology reassessment initiatives.

  • Adam G Elshaug1,2,3
  • Amber M Watt2
  • Linda Mundy2
  • Cameron D Willis2,4

  • 1 Department of Health Care Policy, Harvard Medical School, Boston, Mass, USA.
  • 2 School of Population Health, University of Adelaide, Adelaide, SA.
  • 3 The Commonwealth Fund, New York, NY, USA.
  • 4 Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada.


Funding for this project was provided by the Australian Government Department of Health and Ageing. The findings and views expressed in this article are those of the authors and do not necessarily represent those of the Commonwealth Fund, including its directors, officers or staff, or those of the Australian Government Department of Health and Ageing. Adam Elshaug and Cameron Willis hold NHMRC Fellowships (627061 and 1013165, respectively). We are grateful to Amy Lambart and Kelly Cameron of the Department of Health and Ageing for their thoughtful guidance and insight throughout the design and subsequent implementation of this project.

Competing interests:

No relevant disclosures.

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