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Objective To characterize racial differences in receipt of low value care (services that provide little to no benefit yet have potential for harm) among older Medicare beneficiaries overall and within health systems in the United States. Design Retrospective cohort study Setting 100% Medicare fee-for-service administrative data (2016–18). Participants Black and White Medicare patients aged 65 or older as of 2016 and attributed to 595 health systems in the United States. Main outcome measures Receipt of 40 low value services among Black and White patients, with and without adjustment for patient age, sex, and previous healthcare use. Additional models included health system fixed effects to assess racial differences within health systems and separately, racial composition of the health system’s population to assess the relative contributions of individual patient race and health system racial composition to low value care receipt. Results The cohort included 9 833 304 patie

United statesMatthewb mackwoodNancye mordenIshani ganguliMaia crawfordA james omalleyElliotts fisherKathleenl mulliganChing wen wendy yangResearch triangle instituteNational drug codeMedicare shared savings programNational academy of medicineMilliman medinsight health waste calculatorNational institute onMedicaid services