What Low-Value Care Means for Health Equity

The coronavirus pandemic has laid bare the significant health disparities present within the American health care system. Not only has the virus taken a serious toll on communities of color, these communities have traditionally faced challenging environments and structural conditions that have led to less wealth, fewer opportunities, and poorer health. Expanding access to health care to underserved communities is an important strategy in advancing health equity; however, not all health care that is routinely provided improves health outcomes. In fact, recent studies have shown that as much as one-quarter of total US health care spending is wasteful, some of which is in the form of low-value services that provide little to no benefit to patients.

In a recent paper for the Research Consortium for Health Care Value Assessment, we discuss how low-value care can impose serious burdens on patients in the form of potential harm, unnecessary costs, and wasted resources that could be better used elsewhere. We then review the mixed evidence demonstrating the relationship between health care access among disadvantaged populations and the prevalence of low-value care and pose key questions that policymakers and researchers should investigate to fill existing knowledge gaps.

A high prevalence of low-value care creates systemic costs and resource tradeoffs including:

Lost time and transportation challenges which may be especially high for people of color. The risk of adverse outcomes from low-value care or the risk of false positives from low-value diagnostic procedures (which lead to additional burdens of cost and stress) are more impactful for those who have less flexibility and fewer resources and social supports.

Financial burdens which can be particularly challenging for those without insurance coverage. Even for those with insurance, low-value care drives up out-of-pocket costs as patients must still meet deductibles or have additional cost-sharing arrangements.

Tradeoffs between health spending and non-health priorities. In a private insurance environment, higher spending on low-value care translates into higher insurance premiums (or less generous coverage) which can have a cascading effect on wages as health expenses grow to be a larger share of employee compensation. In a publicly funded environment, the more that is spent on health care, the less there is available to fund other priorities such as social services, education or infrastructure.

Erosion of trust in the health care system, which may discourage patients from seeking needed care.  Research shows that non-Hispanic Blacks were less likely to trust their physicians than non-Hispanic Whites, and that non-Hispanic Blacks were more concerned about their personal privacy and potential for harmful experimentation in hospitals compared to their non-Hispanic White counterparts.

From our review of the evidence, the relationship between increased care access and the likelihood of receiving low-value care needs to be better understood. Some researchers have found low-value care to be less prevalent among communities of color, though that may be due to these groups underutilizing health services overall. Others, including a recent review of Medicare claims data, found the opposite – for certain services Black and Hispanic patients were often more likely to receive services of low value.  Answering these questions through further study of the prevalence and impact of low-value on underserved and marginalized groups will better inform efforts to leverage limited resources to increase health care access, improve health, and support greater equity.

To view our full paper, please visit the Research Consortium’s website HERE.

Beth Beaudin-Seiler, PhD is the Manager of the Value Consortium and a Senior Analyst at Altarum. Ani Turner, MA is a Senior Economist at Altarum.