Doing What Works: The Public’s Perspectives on Reducing Unnecessary, Harmful, or Wasteful Care
The three largest purchasers in California — the Department of Health Care Services, Covered California, and CalPERS — established a statewide workgroup to develop and implement strategies to reduce care that is unnecessary, wasteful, or harmful. To inform the workgroup, CHCF funded the Center for Healthcare Decisions (CHCD) to implement the Doing What Works project to assess public views and values on specific strategies to address the problem.
CHCD conducted 10 intensive half-day deliberative sessions from September to December 2015 with 117 California residents with Medi-Cal coverage, as well as lower- to middle-income health plan members from Covered California and CalPERS, to answer this question: What strategies are most acceptable for reducing the use of medical care that is harmful and/or wasteful? Participants received factual background information about overuse of three common medical services — antibiotics for adult bronchitis, c-sections for first-time normal deliveries, and MRIs for common low back pain — and then discussed options for reducing inappropriate use.
- 57% supported physician oversight. This approach proposed to change physician behavior through external approval, internal monitoring, or establishing stricter rules for when the intervention will be covered.
- 21% supported patient cost sharing. A minority believed that the most productive approach was to have patients be financially responsible (such as a higher copayment or paying the extra cost) if they insisted on an ineffective medical intervention.
- 13% supported physician payment. A much smaller percentage supported financial disincentives through penalties or nonpayment to physicians.
- 9% supported taking no action. Less than 1 in 10 believed in leaving the decision entirely to individual doctors and patients.
The full report is available on the CHCD website through the External Link below. The executive summary is available as a Document Download.