TY - JOUR A1 - Saini, Vikas A1 - Garcia-Armesto, Sandra A1 - Klemperer, David A1 - Paris, Valerie A1 - Elshaug, Adam G. A1 - Brownlee, Shannon A1 - Ioannidis, John P. A. A1 - Fisher, Elliott S. T1 - Drivers of poor medical care JF - The Lancet N2 - The global ubiquity of overuse and underuse of health-care resources and the gravity of resulting harms necessitate an investigation of drivers to inform potential solutions. We describe the network of influences that contribute to poor care and suggest that it is driven by factors that fall into three domains: money and finance; knowledge, bias, and uncertainty; and power and human relationships. In each domain the drivers operate at the global, national, regional, and individual level, and are modulated by the specific contexts within which they act. We discuss in detail drivers of poor care in each domain. KW - CONFLICTS-OF-INTEREST KW - CORONARY-ARTERY-DISEASE KW - EMERGENCY-DEPARTMENT KW - HEALTH-CARE KW - INFORMED-CONSENT KW - PHARMACEUTICAL-INDUSTRY KW - SHARED DECISION-MAKING KW - SOCIAL DETERMINANTS KW - SOCIOECONOMIC DISPARITIES KW - UNITED-STATES Y1 - 2017 U6 - https://doi.org/10.1016/S0140-6736(16)30947-3 VL - 390 IS - 10090 SP - 178 EP - 190 PB - Elsevier ER -