Advancing the ‘Choosing Wisely’ campaign to reduce low-value care in China

Jay Pan and colleagues stress that reducing low-value medical services and enhancing healthcare quality must be an urgent priority in China; advancing the Choosing Wisely initiative represents a critical strategy to achieve this goal while also contributing to the global evolution of the Choosing Wisely International campaign. As evidence-based medicine continues to shape clinical decision-making, the definition of ‘high-quality’ healthcare has come to encompass not only the comprehensiveness of services provided but also the reduction of unnecessary and potentially harmful interventions.1 LVC refers to medical practices that provide minimal or no clinical benefit or whose potential harms may outweigh anticipated advantages.2 LVC poses a significant threat to the healthcare system’s efficiency and patient safety.3 While direct evidence remains limited, several empirical indicators point to the widespread prevalence of LVC in China. For instance, studies on irrational drug use have revealed outpatient antibiotic prescription rates exceeding 40%, significantly higher than the 15%–18% reported in the USA and more than double the WHO’s recommended threshold.4 Similarly, certain low-value surgical procedures—including vesicoureteral reflux surgery, renal artery stenting, anterior colporrhaphy and spinal fusion—have increased at annual rates exceeding 20%.5 Although comprehensive empirical mapping of LVC in China is still lacking, international studies have shown that low-value tests and treatments impose substantial burdens on health system efficiency and patient safety.5 The persistence of LVC in China reflects a multifactorial interplay of systemic and sociocultural determinants. First, pervasive health illiteracy and entrenched information asymmetry often lead patients to equate ‘more care’ with ‘better care’, thus fuelling demand for unnecessary services. The lack of effective communication tools further impedes the implementation of shared decision-making. Second, a medicolegal environment marked by frequent disputes and ambiguous professional accountability fosters defensive medical practices.6 To mitigate the perceived risks of misdiagnosis or litigation, clinicians …