Why Do Patients Demand Low-Value Care?

by Jon Scaccia January 27, 2025

Emma, a 42-year-old teacher, feels a twinge in her back after a weekend hike. Concerned, she requests an MRI from her doctor. Despite reassurance that rest and physical therapy are sufficient, Emma insists. Why? She believes “more is better,” a common mindset in healthcare. This scenario isn’t unique—it’s part of a global challenge called low-value care, which accounts for a significant chunk of healthcare spending without improving outcomes.

A recent scoping review shines a light on this issue, uncovering why patients like Emma demand unnecessary medical interventions. Let’s delve into the science, unpack the factors driving these choices, and explore what it means for public health.

What Is Low-Value Care and Why Does It Matter?

Low-value care refers to medical interventions that offer little to no health benefit and may even cause harm. Examples include routine imaging for nonspecific back pain, unnecessary antibiotics, and redundant cancer screenings. Globally, these practices consume 20% or more of healthcare budgets. In the United States alone, the cost exceeds billions annually.

Reducing low-value care is about more than saving money. It’s about improving healthcare quality and ensuring resources go where they’re truly needed. But to address the problem, we first need to understand its roots—and that’s where patients come in.

The Eight Drivers of Low-Value Care

The study identified eight key themes influencing patients’ demand for low-value care. Here’s a closer look:

1. Cognitive Biases: Our brains love shortcuts, but these mental habits can backfire in healthcare. For example:
   • “More is better” bias: Patients equate more tests or treatments with better care.
   • Risk aversion: Fear of missing a diagnosis drives demand for unnecessary screenings.
   • Anticipated regret aversion: “Better safe than sorry” often leads to over-testing.
2. Emotions: Fear, anxiety, and a need for control often compel patients to seek reassurance through excessive care. For example, yearly check-ups may reduce anxiety but provide little medical value.
3. Preferences and Expectations: Past experiences shape expectations. If a previous doctor always ordered imaging for back pain, a patient may insist on the same, even if it’s unnecessary.
4. Knowledge-Related Factors
   • Limited health literacy: Misunderstanding medical information can fuel misguided requests.
   • Over-information: On the flip side, patients overwhelmed by data may demand care that seems safest—even if it isn’t.
5. Socio-Cultural Factors: Social norms and life stages play a role. For instance, younger patients may push for aggressive treatments to maximize future opportunities.
6. Economic Factors
   • Consumerism: Viewing healthcare as a product leads some patients to “shop around” for their desired care.
   • Insurance coverage: When costs are covered, patients may feel less restrained in requesting unnecessary interventions.
7. Biomedical and Care-Related Factors: Chronic symptoms, pain, or severe illnesses often lead patients to pursue care beyond what’s necessary. For example, patients with persistent migraines may overuse emergency services.
8. Healthcare Provider Interaction: Trust (or lack thereof) in healthcare providers significantly impacts decision-making. Patients who doubt their doctor’s judgment may seek referrals or second opinions unnecessarily.

Why Patients’ Choices Matter for Public Health

The demand for low-value care doesn’t just affect individuals like Emma. It has ripple effects:

• Overburdened systems: Resources spent on unnecessary care strain healthcare systems, limiting access for those in genuine need.
• Potential harm: Unnecessary tests and treatments can lead to complications, anxiety, or false positives.
• Erosion of trust: When patients demand care that clinicians view as unnecessary, it can strain relationships and diminish trust.

Turning Insight Into Action

How can we reduce low-value care while respecting patients’ concerns? Here are some actionable strategies:

• Improve Health Literacy: Simplify medical communication to help patients understand the risks and benefits of interventions.
• Foster Shared Decision-Making: Equip clinicians with tools to guide conversations about what’s necessary and why.
• Address Cognitive Biases: Public awareness campaigns can challenge myths like “more is better.”
• Redefine Success: Shift cultural narratives to value appropriate care over excessive care. For example, celebrating “the right care at the right time.”

What’s Next?

This review highlights areas ripe for further exploration:

• Complex Interactions: How do these drivers overlap and interact? For example, do cognitive biases amplify emotional responses?
• Cultural Contexts: How do healthcare systems in different countries shape patient demand for low-value care?
• Intervention Effectiveness: Which strategies best address demand-side drivers without undermining trust?

The journey to reducing low-value care is complex, but understanding these drivers is a crucial first step. Tackling this issue requires collaboration between patients, providers, and policymakers to ensure healthcare systems remain sustainable and effective.

Join the Conversation

We want to hear from you! How does low-value care affect your community? What strategies have you seen work in addressing unnecessary care? Share your thoughts below or join the discussion on social media. Let’s reimagine healthcare together.

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