"Choosing wisely" to reduce low-value care: a conceptual and ethical analysis

Area of Science:

• Medical Ethics
• Health Policy
• Healthcare Management

Background:

• The American Board of Internal Medicine (ABIM) Foundation launched
• Choosing Wisely
• to decrease low-value healthcare services.

Purpose of the Study:

• To achieve conceptual clarity on the definition of
• low-value care
• and identify ethical challenges in its reduction.

Main Methods:

• Categorization of low-value care into 10 distinct types.
• Ethical analysis using Rawlsian and Hegelian justice concepts.
• Examination of physician fiduciary obligations.
• Outline of mechanisms for reducing low-value care.

Main Results:

• Identification of 10 distinct categories of low-value care.
• Discussion of ethical challenges for each category.
• Justification for reducing specific low-value care categories.
• Proposal of various reduction mechanisms (incentives, punishments, behavioral influences, environmental design).

Conclusions:

• Conceptual clarity on "low-value care" is crucial.
• Ethical frameworks support the reduction of certain low-value care services.
• Normative guidelines are needed for implementing reduction strategies.