Disinvestment in the age of cost-cutting sound and fury. Tools for the Spanish National Health System

García-Armesto, Sandra; Campillo-Artero, Carlos; Bernal‐Delgado, Enrique

doi:10.1016/j.healthpol.2013.01.007

Cited by 35 publications

(46 citation statements)

References 8 publications

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“…This study also addresses the lack of models and frameworks noted in the disinvestment literature [4, 5, 8, 10, 11, 19, 149, 157–159]. Firstly, a framework and taxonomy for evaluation and explication of implementation of change have been adapted specifically for use in disinvestment projects.…”

Section: Resultsmentioning

confidence: 99%

Sustainability in Health care by Allocating Resources Effectively (SHARE) 6: investigating methods to identify, prioritise, implement and evaluate disinvestment projects in a local healthcare setting

Harris

Allen

Brooke

et al. 2017

BMC Health Serv Res

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BackgroundThis is the sixth in a series of papers reporting Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The SHARE program was established to investigate a systematic, integrated, evidence-based approach to disinvestment within a large Australian health service. This paper describes the methods employed in undertaking pilot disinvestment projects. It draws a number of lessons regarding the strengths and weaknesses of these methods; particularly regarding the crucial first step of identifying targets for disinvestment.MethodsLiterature reviews, survey, interviews, consultation and workshops were used to capture and process the relevant information. A theoretical framework was adapted for evaluation and explication of disinvestment projects, including a taxonomy for the determinants of effectiveness, process of change and outcome measures. Implementation, evaluation and costing plans were developed.ResultsFour literature reviews were completed, surveys were received from 15 external experts, 65 interviews were conducted, 18 senior decision-makers attended a data gathering workshop, 22 experts and local informants were consulted, and four decision-making workshops were undertaken. Mechanisms to identify disinvestment targets and criteria for prioritisation and decision-making were investigated. A catalogue containing 184 evidence-based opportunities for disinvestment and an algorithm to identify disinvestment projects were developed. An Expression of Interest process identified two potential disinvestment projects. Seventeen additional projects were proposed through a non-systematic nomination process. Four of the 19 proposals were selected as pilot projects but only one reached the implementation stage. Factors with potential influence on the outcomes of disinvestment projects are discussed and barriers and enablers in the pilot projects are summarised.ConclusionThis study provides an in-depth insight into the experience of disinvestment in one local healthcare service. To our knowledge, this is the first paper to report the process of disinvestment from identification, through prioritisation and decision-making, to implementation and evaluation, and finally explication of the processes and outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2269-1) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Sustainability in Health care by Allocating Resources Effectively (SHARE) 6: investigating methods to identify, prioritise, implement and evaluate disinvestment projects in a local healthcare setting

Harris

Allen

Brooke

et al. 2017

BMC Health Serv Res

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“…García-Armesto and colleagues reviewed the instruments necessary and the barriers to implementing a value-for-money approach in the SNS (9). They identified the factors required as a regulatory framework, identification of lowvalue interventions, best practice guidance, and monitoring of enforced guidance.…”

Section: Revisiting the Portfolio Of Free Servicesmentioning

confidence: 99%

“…They suggested that, although the enabling elements of a disinvestment strategy have been in place in the SNS for years, it remains absent from the political agenda. They also suggested identifying low-value procedures and effective alternatives to encourage local disinvestment by increasing the knowledge base, which might improve the global efficiency and capacity of the SNS over time (9).…”

Section: Revisiting the Portfolio Of Free Servicesmentioning

confidence: 99%

The Painful Effects of the Financial Crisis on Spanish Health Care

Bosch¹,

Moreno²,

López‐Soto³

2014

Int J Health Serv

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Spain has an advanced, integrated health care system that has achieved remarkable results, including substantially improved health outcomes, over a relatively short time. Measures introduced by central and regional governments to combat the financial crisis may be severely affecting the health sector, with proposed changes potentially threatening the principles of equity and social cohesion underlying the welfare state. This article examines recent developments in Spanish health care, focusing on the austerity measures introduced since 2010. In Spain, as in other countries, evaluation of health care changes is difficult due to the paucity of data and because the effects of measures often lag well behind their introduction, meaning the full effects of changes on access to care or health outcomes only become apparent years later. However, some effects are already clear. With exceptions, Spain has not used the crisis as an opportunity to increase efficiency and quality, rationalize and reorganize health services, increase productivity, and regain public trust. We argue that immediate health care cuts may not be the best long-term answer and suggest evidence-driven interventions that involve the portfolio of free services and the private sector, while ensuring that the most vulnerable are protected.

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“…This model makes a contribution to the lack of frameworks and models noted in the disinvestment literature [3, 4, 7, 9, 10, 38, 42, 83–86]. It presents opportunities and potential activities for consumer engagement in resource allocation decision-making.…”

Section: Resultsmentioning

confidence: 99%

Sustainability in health care by allocating resources effectively (SHARE) 4: exploring opportunities and methods for consumer engagement in resource allocation in a local healthcare setting

Harris

Waller

et al. 2017

BMC Health Serv Res

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BackgroundThis is the fourth in a series of papers reporting a program of Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. Healthcare decision-makers have sought to improve the effectiveness and efficiency of services through removal or restriction of practices that are unsafe or of little benefit, often referred to as ‘disinvestment’. A systematic, integrated, evidence-based program for disinvestment was being established within a large Australian health service network. Consumer engagement was acknowledged as integral to this process. This paper reports the process of developing a model to integrate consumer views and preferences into an organisation-wide approach to resource allocation.MethodsA literature search was conducted and interviews and workshops were undertaken with health service consumers and staff. Findings were drafted into a model for consumer engagement in resource allocation which was workshopped and refined.ResultsAlthough consumer engagement is increasingly becoming a requirement of publicly-funded health services and documented in standards and policies, participation in organisational decision-making is not widespread. Several consistent messages for consumer engagement in this context emerged from the literature and consumer responses. Opportunities, settings and activities for consumer engagement through communication, consultation and participation were identified within the resource allocation process. Sources of information regarding consumer values and perspectives in publications and locally-collected data, and methods to use them in health service decision-making, were identified. A model bringing these elements together was developed.ConclusionThe proposed model presents potential opportunities and activities for consumer engagement in the context of resource allocation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2212-5) contains supplementary material, which is available to authorized users.

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Disinvestment in the age of cost-cutting sound and fury. Tools for the Spanish National Health System

Cited by 35 publications

References 8 publications

Sustainability in Health care by Allocating Resources Effectively (SHARE) 6: investigating methods to identify, prioritise, implement and evaluate disinvestment projects in a local healthcare setting

Sustainability in Health care by Allocating Resources Effectively (SHARE) 6: investigating methods to identify, prioritise, implement and evaluate disinvestment projects in a local healthcare setting

The Painful Effects of the Financial Crisis on Spanish Health Care

Sustainability in health care by allocating resources effectively (SHARE) 4: exploring opportunities and methods for consumer engagement in resource allocation in a local healthcare setting

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