Low Value Care
Up to one fifth of what health systems fund makes no measurable difference to patient outcomes.
Healthcare systems across Europe and the Gulf continue to fund care that clinical evidence does not support. Zeumed works with payers and governments to identify where unnecessary care persists, quantify its cost, and redesign the payment structures that sustain it.
€1.7 trn
Annual EU healthcare expenditure. However up to one fifth estimated to deliver no patient benefit
€5bn - 15bn
Estimated unnecessary ambulatory care in Germany alone
60%
Rise in average adult private health insurance premiums in Ireland since 2019
58%
Reduction in low value testing for Vitamin D in Switzerland within six months of a single coverage restriction
WHY IT PERSISTS
The scale of unnecessary care is well documented, and in many systems the clinical case for acting on it has already been made. The problem is not that this evidence does not exist — it is that it has not been consistently translated into how care is paid for.
Where reimbursement schedules continue to fund services regardless of clinical appropriateness, and where the tariff for a procedure exceeds the tariff for conservative management of the same presentation, the incentive to deliver unnecessary care remains intact. Professional guidance and awareness programmes have produced limited and uneven reductions in most systems where they have been evaluated. The clearest reductions, including Norway's 33–48% fall in unnecessary knee arthroscopies and Switzerland's 58% reduction in low value testing, were achieved through direct changes to reimbursement conditions, not through guidance alone.
This is a payment design problem. It requires a payment design response.
HOW WE WORK
Reducing unnecessary care in a funded health system requires three things: locating where it is occurring and at what scale, quantifying its clinical and financial impact in your specific system, and redesigning payment structures so that reimbursement reflects the evidence without disrupting access to appropriate care.
Design and evaluation of pricing and reimbursement mechanisms;
Quantitative modelling of budget impact, utilisation, and fiscal exposure;
Assessment of evidence requirements and decision criteria within local systems;
Scenario analysis of pricing and access options across heterogeneous Gulf markets.
IDENTIFY
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Claims data analysis cross-referenced against ICD diagnostic codes and prior utilisation history
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Benchmarking against peer institutions and unwarranted variation analysis where clinical guidance does not yet exist
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Output: a defined set of services, volumes and providers where unnecessary activity is occurring at financially material scale
MEASURE
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Patient journey tracing to assess downstream utilisation and complication rates — distinguishing procedures that reduce total treatment burden from those that do not
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Tariff differential mapping to identify where the gap between operative and conservative management creates a financial incentive to intervene
REDESIGN
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Scenario modelling of reimbursement options before implementation, including provider-level revenue exposure at different magnitudes of change
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Complexity adjustment to ensure high-acuity care is not inadvertently disadvantaged by changes targeting low-value activity
CASE STUDY
Unnecessary arthroscopy in an insured population: from claims analysis to policy options
A public insurer engaged Zeumed to examine whether its funded arthroscopy activity was clinically justified. The answer, based on ICD-level claims classification against evidence-based criteria, was that 20% of procedures were delivered to patients whose diagnosis did not support surgical intervention. This represented 13% of total arthroscopy expenditure within the insured population.
Provider-level analysis identified where that activity was concentrated and quantified the revenue exposure of affected hospitals under alternative policy scenarios: tariff adjustment, prior authorisation, and coverage restriction with defined clinical thresholds. Each scenario was modelled for its likely effect on treatment mix, patient flow, and insurer expenditure.
The work gave the insurer something it did not previously have: a precise, defensible account of where unnecessary activity was occurring, at what cost, and what the financial consequences of different interventions would be before any were implemented.
20%
of funded arthroscopies were found to be clinically inappropriate
13%
of total arthroscopy expenditure was for inappropriate cases
WHITE PAPER
Low Value Care: Why Payment Design Matters
Our white paper sets out the evidence on the scale of unnecessary care across European and international health systems, examines why guidance-based approaches have produced limited results, and presents a measurement-led framework for aligning reimbursement structures with clinical evidence.