Low-cost, high-volume healthcare services contribute the most to low-value care spending in Japan

Abstract Introduction High-income countries face the urgent task of reducing healthcare spending incurred by low-value care. However, evidence is limited as to whether high-cost or low-cost low-value care services contribute more to total unnecessary healthcare spending, especially outside the United States. Methods Using a claims database covering all age groups in Japan from April 2022 to March 2023 (approximately 2 million beneficiaries, or 2% of the total population), we examined 52 low-value care services using two versions of claims-based measures with different sensitivities and specificities (narrower and broader definitions). Results We identified 3.1 million (narrower) to 3.7 million (broader) episodes of low-value care services, accounting for 42.6-67.2 million USD, or 0.7%-1.0% of total healthcare spending. In the narrower definition, lower-cost services (<80 USD per service) contributed to virtually all episodes of low-value care and 67% of total unnecessary healthcare spending—far exceeding the 33% attributed to the higher-cost services (≥80 USD). Conclusion This finding suggests that compared with focusing solely on higher-cost low-value care services, targeting the reduction of frequently performed, lower-cost low-value care services may be a more effective and efficient strategy for reducing wasteful spending.