Value measures the health outcomes that matter to patients for every dollar spent. Health services that fail, for avoidable reasons, to maximise outcomes given available resources can be considered wasteful clinical care. Strong evidence exists that it persists in health care systems. Wasteful clinical care manifests itself in many forms: as avoidable adverse events and as care that is ineffective, inappropriate or poorly cost-effective – from the diagnosis of cancers that will not cause harm, to the sensitive matter of providing futile care near the end of life.This chapter begins by describing the extent of wasteful care and exploring its drivers. Persistent challenges include a lack of metrics to quantify wasteful care and the need to sustainably engage both clinicians and patients to change practices. The chapter concludes by discussing the information systems needed to detect wasteful care and the policy levers to tackle it.

Inappropriate use of antimicrobials is perhaps one of the most threatening forms of wasteful clinical care. This is because inappropriate use of antimicrobials encourages the development of antimicrobial resistance (AMR). This chapter builds on available evidence to present a comprehensive set of policy actions to promote an effective use of antimicrobials. The chapter is divided into five sections. The first section analyses trends in consumption and estimates the share of inappropriate use of antimicrobials in OECD countries. This is followed by an assessment of the current and future health and economic burden caused by inappropriate use of antimicrobials and AMR. Section three spells out the main determinants underlying inappropriate antimicrobial use. Section four assesses the potential effectiveness of policy actions to promote an effective use of antimicrobials. Special emphasis is devoted to education and information activities; to organisational changes; and to a broader use of new technologies. A final section summarises the key policy implications of the chapter.