Summary
As value-based payment models incorporate both measures of health equity and low-value care (LVC), understanding how LVC varies by race is vital for interventions. Authors measured racial differences in LVC in a contemporary sample.
They analyzed claims from adults ≥ 55 years receiving care at five academic medical centers in California from 2019 to 2021. This sample included patients who received a service that could be classified as LVC. The primary outcome was whether a service was classified as LVC. Secondary outcomes included clinical categories of LVC (preventive screening, diagnostic testing, prescription drugs, and preoperative testing).
Findings: Among 15,720 members who received potentially LVC, non-Hispanic white older adults comprised 59% of the sample, followed by Asian (17%), unknown race (8%), Latino (8%), non-Hispanic Black (5%), and other race (2%). Asian, Black, and Latino older adults were less likely to receive LVC compared to white older adults, specifically preventive and preoperative services. Asian, Black, and Latino older adults, however, were more likely to receive low-value prescriptions.
These diverging racial patterns in LVC across different measures likely reflect differential mechanisms, underscoring the need to use clinically specific measures rather than composite measures, which obscure underlying heterogeneity and could lead to potentially harmful and inequity-producing interventions.