Breaking up is hard to do: why disinvestment in medical technology is harder than investment
Abstract
Healthcare technology is a two-edged sword - it offers new and better treatment to a wider range of people and, at the same time, is a major driver of increasing costs in health systems. Many countries have developed sophisticated systems of health technology assessment (HTA) to inform decisions about new investments in new healthcare interventions. In this paper, we question whether HTA is also the appropriate framework for guiding or informing disinvestment decisions. In exploring the issues related to disinvestment, we first discuss the various HTA frameworks which have been suggested as a means of encouraging or facilitating disinvestment. We then describe available means of identifying candidates for disinvestment (comparative effectiveness research, clinical practice variations, clinical practice guidelines) and for implementing the disinvestment process (program budgeting and marginal analysis (PBMA) and related techniques). In considering the possible reasons for the lack of progress in active disinvestment, we suggest that HTA is not the right framework as disinvestment involves a different decision making context. The key to disinvestment is not just what to stop doing but how to make it happen - that is, decision makers need to be aware of funding disincentives. What is known about this topic?: Disinvestment is an increasingly popular topic amongst academics and policy makers. Most discussions focus on the need to increase disinvestment as a corollary of investment, the lack of overt disinvestment decisions and the use of a framework based on health technology assessment (HTA) to implement disinvestment. What does this paper add?: This paper focusses on the difficulties associated with deciding which technologies to disinvest in, and the problems in using an HTA framework to make such decisions, when disinvestment involves a different decision making context from that of investment. What are the implications for practitioners?: The key to disinvestment is not just what to stop doing but how to implement such decisions. Making it happen means being aware of funding disincentives.
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Haas et al. and Robinson et al. describe that there is a lack of financial incentives for healthcare providers to engage in disinvestment.
“Haas et al. and Robinson et al. describe that there is a lack of financial incentives for healthcare providers to engage in disinvestment [24, 39].”
From What influences the outcome of active disinvestment processes in healthcare? A qualitative interview study on five recent cases of active disinvestment (2021) · cites this paper as [39]
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Towards understanding the de-adoption of low-value clinical practices: a scoping review
Niven, D. J., Mrklas, K. J., Holodinsky, J. K., Straus, S. E., Hemmelgarn, B. R., Jeffs, L. P., & Stelfox, H. T. (2015) · BMC Medicine · doi:10.1186/s12916-015-0488-z · Cited by 369 · see citing works
Rotteveel, A. H., Lambooij, M. S., van de Rijt, J. J. A., van Exel, J., Moons, K. G. M., & de Wit, G. A. (2021) · BMC Health Services Research · doi:10.1186/s12913-021-06298-3 · Cited by 16 · see citing works
- Authors
- Haas, M., Hall, J., Viney, R., & Gallego, G.
- Affiliations
- University of Technology Sydney (AU)
- The University of Sydney (AU)
- Corresponding author
- Haas, Marion
- Venue
- Australian Health Review
- Publisher
- CSIRO Publishing
- Published
- 2012-05-25
- Volume
- 36
- Issue
- 2
- Pages
- 148-152
- ISSN
- 0156-5788 (ISSN-L)
- 1449-8944
- OpenAlex
- W2134188352
- Cited by
- 66
- References
- 1
- Citations by year
- 2025: 3 · 2024: 6 · 2023: 6 · 2022: 2 · 2021: 10 · 2020: 6 · 2019: 7 · 2018: 4 · 2017: 9 · 2016: 6 · 2015: 5 · 2014: 1 · 2013: 1
- FWCI
- 4.97
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Australian Health Review (publishedVersion)
- PubMed (publishedVersion)
- UTS ePRESS (University of Technology Sydney) (submittedVersion)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Health Sciences › Health Professions › General Health Professions › Global Health Care Issues
- Keywords
- divestiture, health technology assessment, health care costs, comparative effectiveness research, clinical practice variation, health technology investment, health policy decision-making
- MeSH terms
- Australia, Cost-Benefit Analysis, Decision Making, Organizational, Humans, Investments, Technology Assessment, Biomedical, Comparative Effectiveness Research
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