Evidence That Drives Real Change

Authors: Yeo JX, Tokuda Y, Sasaki S, Pan J, Kamaruzaman H, Ranganathan P, et al.

Year: 2026

Abstract:
Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Authors: Joris L J M Müskens, Rudolf Bertijn Kool, Simone A van Dulmen, Gert P Westert

Year: 2022

Abstract:
Background: Overuse of diagnostic testing substantially contributes to healthcare expenses and potentially exposes patients to unnecessary harm. Our objective was to systematically identify and examine studies that assessed the prevalence of diagnostic testing overuse across healthcare settings to estimate the overall prevalence of low-value diagnostic overtesting.

Methods: PubMed, Web of Science and Embase were searched from inception until 18 February 2020 to identify articles published in the English language that examined the prevalence of diagnostic testing overuse using database data. Each of the assessments was categorised as using a patient-indication lens, a patient-population lens or a service lens.

Results: 118 assessments of diagnostic testing overuse, extracted from 35 studies, were included in this study. Most included assessments used a patient-indication lens (n=67, 57%), followed by the service lens (n=27, 23%) and patient-population lens (n=24, 20%). Prevalence estimates of diagnostic testing overuse ranged from 0.09% to 97.5% (median prevalence of assessments using a patient-indication lens: 11.0%, patient-population lens: 2.0% and service lens: 30.7%). The majority of assessments (n=85) reported overuse of diagnostic testing to be below 25%. Overuse of diagnostic imaging tests was most often assessed (n=96). Among the 33 assessments reporting high levels of overuse (≥25%), preoperative testing (n=7) and imaging for uncomplicated low back pain (n=6) were most frequently examined. For assessments of similar diagnostic tests, major variation in the prevalence of overuse was observed. Differences in the definitions of low-value tests used, their operationalisation and assessment methods likely contributed to this observed variation.

Conclusion: Our findings suggest that substantial overuse of diagnostic testing is present with wide variation in overuse. Preoperative testing and imaging for non-specific low back pain are the most frequently identified low-value diagnostic tests. Uniform definitions and assessments are required in order to obtain a more comprehensive understanding of the magnitude of diagnostic testing overuse.

Authors: OECD

Year: 2017

Abstract:
Following a brief pause after the economic crisis, health expenditure is rising again in most OECD countries. Yet, a considerable part of this health expenditure makes little or no contribution to improving people's health. In some cases, it even results in worse health outcomes. Countries could potentially spend significantly less on health care with no impact on health system performance, or on health outcomes. This report systematically reviews strategies put in place by countries to limit ineffective spending and waste. On the clinical front, preventable errors and low-value care are discussed. The operational waste discussion reviews strategies to obtain lower prices for medical goods and to better target the use of expensive inputs. Finally, the report reviews countries' experiences in containing administrative costs and integrity violations in health.