Reducing Low-Value Care: Uncertainty as Crucial Cross-Cutting Theme: Comment on "Key Factors That Promote Low-Value Care: Views of Experts From the United States, Canada, and the Netherlands"

Low-value care is increasingly recognized as a global problem that places strain on healthcare systems and has no quick fix. Verkerk et al have identified key factors promoting low-value care on a national level, proposed strategies to address these and create a healthcare system facilitating delivery of high-value care. In this commentary, we reflect on the results of Verkerk et al and argue that uncertainty has a crucial role when it comes to reducing low-value care. This uncertainty is reflected in lack of a shared view between stakeholders, with clear criteria and thresholds on what constitutes low-value care, and as cross-cutting theme related to the key factors identified. We suggest to work on such a shared view of low-value care and – different from implementation efforts – to explicitly address uncertainty and its driving cognitive biases grounded in human decision-making psychology, to reduce low-value care.