Exploring policy-makers’ perspectives on disinvestment from ineffective healthcare practices

Abstract

Objectives: Many existing healthcare interventions diffused before modern evidence-based standards of clinical-and cost-effectiveness. Disinvestment from ineffective or inappropriately applied practices is growing as a priority for international health policy, both for improved quality of care and sustainability of resource allocation. Australian policy stakeholders were canvassed to assess their perspectives on the challenges and the nature of disinvestment. Methods: Senior health policy stakeholders from Australia were criterion and snow-ball sampled (to identify opinion leaders). Participants were primed with a potential disinvestment case study and took part in individual semistructured interviews that focused on mechanisms and challenges within health policy to support disinvestment. Interviews were taped and transcribed for thematic analysis. Participant comments were de-identified. Results: Ten stakeholders were interviewed before saturation was reached. Three primary themes were identified. (i) The current focus on assessment of new and emerging health technologies/practices and lack of attention toward existing practices is due to resource limitations and methodological complexity. Participants considered a parallel model to that of Australia's current assessment process for new medical technologies is best-positioned to facilitate disinvestment. (ii) To advance the disinvestment agenda requires an explicit focus on the potential for cost-savings coupled with improved quality of care. (iii) Support (financial and collaborative) is needed for research advancement in the methodological underpinnings associated with health technology assessment and for disinvestment specifically. Conclusions: In this exploratory study, stakeholders support the notion that systematic policy approaches to disinvestment will improve equity, efficiency, quality, and safety of health care, as well as sustainability of resource allocation.Keywords: Disinvestment, Policy, Stakeholder engagement, Health technology assessment, Obsolescence, Cost-effectivenessThe authors gratefully acknowledge all participants for dedicating their time and insights for this project. We also acknowledge Jakob Braunack-Mayer for his assistance with transcribing the interviews reported in this manuscript. Adam Elshaug receives funding from the Faculty of Health Sciences of the University of Adelaide.

Sustainability science: an integrated approach for health-programme planning

“…Built into any programme, therefore, should be questions about planned obsolescence to identify triggers or tipping points for programme re-assessments to decommissioning programmes, or programme components that are no longer needed. 76 Some health programmes are short term and are not intended to be sustained, just as some structural, economic, or political contexts are so unfavourable that sustainability may not be an initial goal. Conceptualising sustainability as a characteristic of systems, however, should encourage planners to undertake explicit activities that engage with the range of programme stakeholders, strengthening the connections and promoting mutual benefi ts.…”

Priority-setting and rationing in healthcare: Evidence from the English experience

“…This approach was chosen to reflect the current focus on disinvestment and service redesign in light of the recent fiscal challenge (Robinson et al, 2011b). Given the wider literature is relatively silent about disinvestment (Elshaug et al, 2008;Robinson et al, 2011b;Hass et al, 2012;Williams et al, 2012), we sought exemplars to identify findings on these topics Case studies were undertaken in two phases. Initially, two case studies were selected for a detailed consideration of priority-setting in terms of the full range of activities conducted in this locality.…”

“…Although the concept of disinvestment is a relatively new area in priority setting, the economic challenge facing healthcare organisations has led many decision makers to look beyond simple efficiency and productivity savings and focus on possible disinvestment strategies -primarily as a means to release resource (Elshaug et al, 2008;Robinson et al, 2011b). Much of the literature treats disinvestment as a means of optimising healthcare through the complete or partial withdrawal of resources from health services or technologies providing relatively little health benefit relative to their cost (Elshaug et al, 2008).…”

“…Much of the literature treats disinvestment as a means of optimising healthcare through the complete or partial withdrawal of resources from health services or technologies providing relatively little health benefit relative to their cost (Elshaug et al, 2008). A wider definition of disinvestment includes the withdrawal or reduction of relatively ineffective healthcare, as well as full withdrawal or rationing of equally worthy alternatives due to resource constraints Daniels et al, forthcoming).…”

Priorities for Health Economic Methodological Research: Results of an Expert Consultation

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