Connect
MJA
MJA

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

Summary

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.


Acknowledgements: 

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.

  • 1. Garner S, Littlejohns P. Disinvestment from low value clinical interventions: NICEly done? BMJ 2011; 343: d4519. doi: 10.1136/bmj.d4519.
  • 2. Cassel CK, Guest JA. Choosing wisely: helping physicians and patients make smart decisions about their care. JAMA 2012; 307: 1801-1802.
  • 3. Medical Benefits Reviews Task Group. Development of a quality framework for the Medicare Benefits Schedule. Discussion paper. Canberra: Australian Government Department of Health and Ageing, 2010. http://www.health. gov.au/internet/main/publishing.nsf/Content/C38EFE94C3035988CA257713001DA46C/$File/Development%20of%20a%20Quality%20Framework%20for%20the%20MBS%20-%20Discussion%20Paper.pdf (accessed Sep 2012).
  • 4. Elshaug AG, Moss JR, Littlejohns P, et al. Identifying existing health care services that do not provide value for money. Med J Aust 2009; 190: 269-273. <MJA full text>
  • 5. Ruano Raviña A, Velasco González M, Varela Lema L, et al. Identification, prioritisation and assessment of obsolete health technologies. A methodological guideline. Santiago de Compostela: Galician Health Technology Assessment Agency, 2009.
  • 6. Ibargoyen-Roteta N, Gutiérrez-Ibarluzea I, Asua J. Guiding the process of health technology disinvestment. Health Policy 2010; 98: 218-226.
  • 7. Nuti S, Vainieri M, Bonini A. Disinvestment for re-allocation: a process to identify priorities in healthcare. Health Policy 2010; 95: 137-143.
  • 8. National Institute for Health and Clinical Excellence. NICE “do not do” recommendations. London: NICE, 2011. http://www.nice.org.uk/usingguidance/donotdorecommendations/index.jsp (accessed Sep 2012).
  • 9. Blue Cross Blue Shield Association. Technology evaluation center assessments. http://www.bcbs.com/blueresources/tec/tec-assessments.html (accessed Sep 2012).
  • 10. Canadian Agency for Drugs and Technologies in Health. Health technology assessment. Ottawa: CADTH, 2012. http://cadth.ca/en/products/health-technology-assessment (accessed Sep 2012).
  • 11. National Health and Medical Research Council. A guide to the development, implementation and evaluation of clinical practice guidelines. Appendix B. Canberra: NHMRC, AusInfo, 1999. http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp30.pdf (accessed Oct 2012).
  • 12. Elshaug AG, Hiller JE, Tunis SR, Moss JR. Challenges in Australian policy processes for disinvestment from existing, ineffective health care practices. Aust New Zealand Health Policy 2007; 4: 23.
  • 13. Cotter D. The National Center For Health Care Technology: lessons learned. Health Affairs Blog 2009; 22 Jan. http://healthaffairs.org/blog/2009/01/22/the-national-center-for-health-care-technology-lessons-learned/ (accessed Sep 2012).
  • 14. Sheingold S, Sheingold BH. Medical technology and the US healthcare system: is this the road to Abilene? World Med Health Policy 2010; 2: Article 5.
  • 15. Wirtz V, Cribb A, Barber N. Reimbursement decisions in health policy – extending our understanding of the elements of decision-making. Health Policy 2005; 73: 330-338.
  • 16. Donaldson C, Bate A, Mitton C, et al. Rational disinvestment. QJM 2010; 103: 801-807.
  • 17. Hodgetts K, Elshaug AG, Hiller JE. What counts and how to count it: physicians’ constructions of evidence in a disinvestment context. Soc Sci Med 2012; Aug 27 [Epub ahead of print].
  • 18. Watt AM, Willis CD, Hodgetts K, et al. Engaging clinicians in evidence-based disinvestment: role and perceptions of evidence. Int J Technol Assess Health Care 2012; 28: 211-219.
  • 19. Henshall C, Schuller T, Mardhani-Bayne L. Using health technology assessment to support optimal use of technologies in current practice: the challenge of “disinvestment”. Int J Technol Assess Health Care 2012; 28: 203-210.

Author

remove_circle_outline Delete Author
add_circle_outline Add Author

Comment
Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.