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CASE STUDIES THAT ILLUSTRATE DISINVESTMENT AND RESOURCE ALLOCATION DECISION-MAKING PROCESSES IN HEALTH CARE: A SYSTEMATIC REVIEW

Published online by Cambridge University Press:  20 March 2013

Julie Polisena ,
Tammy Clifford ,
Adam G. Elshaug ,
Craig Mitton ,
Erin Russell  and
Becky Skidmore
Julie Polisena
Affiliation:
Canadian Agency for Drugs and Technologies in Health Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa
Tammy Clifford
Affiliation:
Canadian Agency for Drugs and Technologies in Health Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa
Adam G. Elshaug
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts School of Population Health, The University of Adelaide
Craig Mitton
Affiliation:
School of Population & Public Health, University of British Columbia Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute
Erin Russell
Affiliation:
Canadian Agency for Drugs and Technologies in Health
Becky Skidmore
Affiliation:
Independent Researcher and Information Specialist
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Abstract

Objective: Technological change accounts for approximately 25 percent of health expenditure growth. To date, limited research has been published on case studies of disinvestment and resource allocation decision making in clinical practice. Our research objective is to systematically review and catalogue the application of frameworks and tools for disinvestment and resource allocation decision making in health care.

Methods: An electronic literature search was executed for studies on disinvestment, obsolete and ineffective technologies, and priority healthcare setting, published from January 1990 until January 2012. Databases searched were MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, Embase, The Cochrane Library, PubMed, and HEED.

Results: Fourteen case studies on the application of frameworks and tools for disinvestment and resource allocation decisions were included. Most studies described the application of program budgeting and marginal analysis (PBMA), and two reports used health technology assessment (HTA) methods for coverage decisions in a national fee-for-service structure. Numerous healthcare technologies and services were covered across the studies. We describe the multiple criteria considered for decision making, and the strengths and limitations of these frameworks and tools are highlighted.

Conclusions: Disinvestment and resource allocation decisions require evidence to ensure their transparency and objectivity. PBMA was used to assess resource allocation of health services and technologies in a fixed budget jurisdiction, while HTA reviews focused on specific technologies, principally in fee-for-service structures. Future research can review the data requirements and explore opportunities to increase the quantity of available evidence for disinvestment and resource allocation decisions.

Keywords

Disinvestmentpriority settingresource allocation health policy
Type
POLICIES
Information
International Journal of Technology Assessment in Health Care , Volume 29 , Issue 2 , April 2013 , pp. 174 - 184
Copyright
Copyright © Cambridge University Press 2013

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