The Fund supports networks of state health policy decision makers to help identify, inspire, and inform policy leaders.
The Milbank Memorial Fund supports two state leadership programs for legislative and executive branch state government officials committed to improving population health.
The Fund identifies and shares policy ideas and analysis to advance state health leadership, strong primary care, healthy aging, and sustainable health care costs.
Keep up with news and updates from the Milbank Memorial Fund. And read the latest blogs from our thought leaders, including Fund President Christopher F. Koller.
The Fund publishes The Milbank Quarterly, as well as reports, issues briefs, and case studies on topics important to health policy leaders.
The Milbank Memorial Fund is is a foundation that works to improve population health and health equity.
Nov 27, 2023
Oct 26, 2023
Oct 11, 2023
Back to The Milbank Quarterly
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 Americans’ understanding of low-value care in 2015, assesses the impact of media messaging, and tests alternative message framing.
Methods: We use a mixed-methods design incorporating (1) 8 focus groups exploring Americans’ understanding of and language for low-value 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 low-value care, and (4) a survey experiment with 785 participants, testing the impact of media messages on attitudes about low-value care, treatment choices, and selection of a primary care clinician.
Findings: One-third of Americans have difficulty envisioning benefits from avoiding low-value 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 low-value 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 low-value 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 low-value 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 fine-tuning how low-value care is characterized. In the longer run, building robust public support for reducing low-value 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.
Author(s): Mark Schlesinger and Rachel Grob
Keywords: low-value care, shared decision making, patient attitudes, patient choice.
Read on Wiley Online Library
Volume 95, Issue 1 (pages 70–116) DOI: 10.1111/1468-0009.12246 Published in 2017
Get the Latest from the Milbank Memorial Fund
The Milbank Quarterly’s multidisciplinary approach and commitment to applying the best empirical research to practical policymaking offers in-depth assessments of the social, economic, political, historical, legal, and ethical dimensions of health and health care policy.