beyond microsystem fixes: targeting national drivers of low-value care comment on “key factors that promote low-value care: views of experts from the united states, canada, and the netherlands”

Low-value care drivers and interventions are often focused on a microsystem (eg, clinic or inpatient ward) or within a health system. identification of national drivers such as payment structure and medical culture of overuse can help identify regional approaches to reducing low-value care. however, these approaches in isolation are insufficient and require additional strategies. these can include policy and payment changes and adopting shared decision-making (sdm). sdm has the potential to move medical culture away from the ‘more is better’ paternalistic and physician-centric culture to one that actively engages patients as full partners in managing their care.