Addressing low-value care (LVC) in Asia: a narrative review of Choosing Wisely and other initiatives across Asia

Low-value care (LVC) research originates predominantly from Western healthcare systems. This narrative review offers the first synthesis of LVC patterns, determinants and reduction initiatives across six diverse Asian countries (Japan, Singapore, South Korea, China, Malaysia and India), comparing them with Western models to inform context-specific de-implementation strategies and identify key priorities for further research.

This is a narrative review of 132 English and non-English literature (2000-2025) from academic databases, grey literature, and policy documents across the six countries that was analysed using a novel framework examining LVC landscapes (healthcare challenges and measurement), determinants (structural, organisational, clinician, patient) and reduction initiatives.

Asian systems mirror Western pressures from demographic shifts, escalating costs and a growing burden of non-communicable diseases, underscoring the urgency of reducing LVC. Despite this, systematic measurement of LVC in Asia remains limited. Common LVC determinants include fee-for-service incentives, medicolegal concerns and a 'more is better' cultural perception, though further research, particularly on cross-country comparisons and from the patient's perspective, is needed. LVC reduction initiatives are still emerging in Asia, with existing approaches shaped by local cultural norms and resource constraints, suggesting that Western strategies provide valuable insights but require adaptation for successful local de-implementation.

This multicountry review establishes a foundation for further collaborative LVC research in Asia via a holistic framework linking country-specific contexts to tailor de-implementation strategies. Key priorities for LVC research in Asia include systematic LVC quantification, development of contextualised evidence-based recommendations and implementation of contextualised multicomponent interventions, supported by further research and regional collaboration.