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Low-Value Medical Services in the Safety-Net Population
Michael L Barnett1, Jeffrey A Linder2, Cheryl R Clark2
1Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts2Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
JAMA Internal Medicine
|April 11, 2017
Summary
Low-value care is common in uninsured and Medicaid patients, but rates are similar to privately insured patients. Safety-net physicians provide comparable care, suggesting targeted interventions for cost savings and quality improvement.
Area of Science:
- Health Services Research
- Health Policy
- Quality of Care
Background:
- National data on low-value and high-value care for uninsured or Medicaid patients are lacking.
- Understanding these patterns is crucial for informing public policy and improving healthcare delivery.
Purpose of the Study:
- To compare rates of low-value and high-value care for uninsured/Medicaid patients versus privately insured patients.
- To assess care delivery by safety-net physicians versus non-safety-net physicians.
Main Methods:
- Cross-sectional observational study using National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey data (2005-2013).
- Included 193,062 office visits for patients aged 18-64 eligible for 21 care measures.
- Multivariable logistic regression adjusted for patient and physician characteristics.
Main Results:
- Low-value and high-value care were delivered in 19.4% and 33.4% of eligible encounters, respectively.
- Care delivery rates were largely similar across insurance types and between safety-net and non-safety-net physicians.
- No significant differences in most low-value or high-value care measures were observed between patient groups or physician types.
Conclusions:
- Overuse of low-value care is prevalent among uninsured and Medicaid patients.
- Physicians serving vulnerable populations deliver care at rates similar to other physicians.
- Targeting low-value care in state Medicaid programs and safety-net institutions can improve quality and reduce costs.