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Disinvestment in healthcare: a scoping review of systematic reviews

Published online by Cambridge University Press:  20 July 2022

Hanin Farhana Kamaruzaman*
Affiliation:
Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom Malaysian Health Technology Assessment Section, Medical Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
Eleanor Grieve
Affiliation:
Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
Olivia Wu
Affiliation:
Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
*
*Author for correspondence: Hanin Farhana Kamaruzaman, E-mail: haninfarhana@gmail.com

Abstract

Objectives

Disinvestment from low value health technologies is growing globally. Diverse evidence gathering and assessment methods were used to implement disinvestment initiatives, however, less than half of the empirical studies report reduced use of the low-value services. This scoping review aimed to synthesize the information from available reviews on the concepts and purposes of disinvestment in healthcare, the approaches and methods used, the role of stakeholders and facilitators and barriers in its implementation.

Methods

This scoping review was guided by the Joanna Briggs Institute Manual for Evidence Synthesis and PRISMA statement for scoping review. Published reviews on disinvestment were identified from scientific databases including health technology assessment (HTA) Web sites using the terms “disinvestment,” “health technology reassessment,” and “healthcare.” The data obtained was synthesized narratively to identify similarities and differences across the approaches based on the prespecified categories.

Results

Seventeen reviews were included with thirty-four initiatives identified across sixteen countries at various levels of implementation and responsible agencies for the activities. Two most used methods to facilitate disinvestment decisions are Programme Budgeting and Marginal Analysis (PBMA) and HTA. Stakeholder involvement is the most important aspect to be addressed, as it acts as both facilitator and barrier in disinvestment initiatives implementation.

Conclusions

Disinvestment programs have been implemented at multilevel, involving multistakeholders and using multiple methods such as PBMA and HTA. However, there is a lack of clarity on the additional dimensions of technical analysis related to these tools. Further research could focus on technology optimization in healthcare as part of overall health technology management.

Type
Assessment
Copyright
© The Author(s), 2022. Published by Cambridge University Press

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Footnotes

We would like to thank the members of Health Economics and Health Technology Assessment (HEHTA), University of Glasgow, for their helpful discussions on this work.

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