Table 5 Examples of reasons for disinvestment from the literature

Any reason

This is the broadest sense of disinvestment and refers to cessation or limitation of something that was previously in practice. It could apply to services, programs, use of equipment, diagnostic tests or therapeutic interventions. Words used interchangeably with disinvestment in this context are decommissioning, de-implementation, removal, replacement, restriction

To optimise health care

This is also a broad concept. It incorporates investment, disinvestment and reinvestment. The focus is on effective allocation of resources to achieve maximum benefit and combines the concepts of safety, effectiveness, cost-effectiveness and eliminating waste. The approach of ‘optimal targeting’ is also captured here.

To optimise resource use

A similarly broad concept to optimising health care with considerable overlap of intentions. The difference is in the emphasis on economic outcomes rather than other aspects of health care. This is the objective of Program Budgeting Marginal Analysis (PBMA) and other prioritisation activities.

To improve patient outcomes

This relates to removal of harmful or ineffective practices which result in adverse outcomes for patients and/or replacement with more effective alternatives. The focus is safety and effectiveness but the terms ‘low value’ and ‘of little or no health gain‘are also used in this context. There is potential to increase costs rather than save money.

To reduce waste

This could also be thought of as improvement in health service outcomes. From the perspective of disinvestment this primarily addresses inappropriate use of diagnostic tests and therapeutic interventions and failure of care coordination.

To get value for money

This is based on consideration of cost-effectiveness and/or risk-benefit analysis. It may be defined by specifying acceptable cost/QALY ratios or based on local values.

To release resources

This can have two elements: to save money in times of financial constraint or to redirect funds to a preferred alternative. Terms used in this context are cost saving, rationing, priority setting, reinvestment and reallocation. Priority setting exercises may also have this as an objective to use disinvestment to enable investment.

To withdraw funding

The focus of this concept is on the process of disinvestment rather than the reason for doing it. Disinvestment defined in this way refers to the act of withdrawing funding from a provider organisation which results in cessation of a service.