In January 2017, the Organisation for Economic Co-operation and Development (OECD) released its Tackling Wasteful Spending on Health report. While drivers for health system waste are complex and varied, the report highlights the contributing role of wasteful clinical care. This includes avoidable instances when patients don’t receive the right care, such as duplication of services, preventable clinical adverse events and low-value care.
Choosing Wisely seeks to reduce the incidence of patients not receiving the right care by supporting a culture shift in how we think about healthcare. Specifically, Choosing Wisely encourages conversations between patients and health professionals about what tests, treatments and procedures are truly needed. Intentionally health profession-led, the initiative provides a platform for both health professionals and consumers to take a leadership role in influencing change.
The OECD states sustainable change can be achieved if patients and clinicians are persuaded that the better option is the less harmful or least wasteful one. As a result of the international interest in Choosing Wisely, the OECD has developed common indicators of overuse. Its report includes three measures aligned with Choosing Wisely recommendations. These measures for antibiotic overuse, unnecessary low-back imaging and unnecessary benzodiazepine use in the elderly were developed and are being reported on across OECD member countries.
At a national policy level, Australia is witnessing an increased focus on high-value and sustainable care. This is evidenced by the current Commonwealth Department of Health’s Medicare Benefits Schedule (MBS) Review, which has adopted a clinician-led approach to review the clinical utility of items currently funded on the MBS. State-based initiatives such as Better Care Victoria seek to support timely and appropriate access to the highest quality of care for Victorians, while the Queensland Clinical Senate is promoting value-based healthcare and encourages shifting from volume to value. At the same time, the Australian Atlas of Healthcare Variation continues to highlight variations in healthcare across the country that serve as a starting point for broader investigation of low-value services. In each case, Choosing Wisely has been identified as a potential enabler for change through its clinician-led and consumer-centred approach.