Table 4 Examples of definitions for ‘disinvestment’
Definition | Measure | Decision criteria | Position | Action |
|---|---|---|---|---|
Disinvestment is an explicit process of taking resources from one service in order to use them for other purposes that are believed to be of better value [28] | Any | Less value than available alternative | Relative | Reallocation |
Disinvesting in health interventions that offer no or low health gain (eg are unproven, outdated or cost ineffective) provides an opportunity to invest in alternative proven and cost effective health interventions [132] | Effectiveness, Currency, Cost-effectiveness | Unproven, outdated or cost-ineffective | Absolute | Reallocation |
Disinvestment is the process of reducing or ceasing health technologies and clinical practices that provide less favourable outcomes than known alternatives [27] | Any | Less favorable outcome than available alternative | Relative | Removal or Restriction |
Disinvestment relates to the withdrawing (partially or completely) of health care practices, procedures, technologies and pharmaceuticals that are deemed to deliver no or low health gain and are thus not efficient or appropriate health resources allocations [91] | Effectiveness | No or low health gain | Absolute | Removal or Restriction |
Disinvestment can take a number of forms in a healthcare setting…and includes full withdrawal or decommissioning, retraction, restriction and substitution [101] | Any | Unspecified | Unspecified | Removal, Restriction or Replacement |
Disinvestment refers to processes by which a health system or service removes technologies, without necessarily replacing them [42] | Any | Unspecified | Unspecified | Removal |
Disinvestment relates to the withdrawal of funding from a provider organisation and the subsequent stopping of the service [104] | Any | Unspecified | Unspecified | Defunding (resulting in Removal) |
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 [60] | â–ª Effectiveness â–ª Affordability | â–ª Relatively ineffective â–ª Unspecified | â–ª Relative â–ª Absolute | Removal or Restriction |
Disinvestment: the displacement of non–cost-effective technologies for resource reinvestment or reallocation [118] | Cost-effectiveness | Non–cost-effective | Absolute | Reallocation |
Disinvestment involves the development and application of epidemiological, economic, ethical and policy appraisals of existing health care interventions that are cost-ineffective or inappropriately applied within health care, leading to displacement of these practices to make way for resource re-allocation towards practices and programs offering greater benefit [163] | â–ª Cost-effectiveness â–ª Appropriate use | â–ª Cost-ineffective â–ª Inappropriate use | Absolute | Removal and Reallocation |