Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-06T09:42:41.615Z Has data issue: false hasContentIssue false

Exploring policy-makers’ perspectives on disinvestment from ineffective healthcare practices

Published online by Cambridge University Press:  24 January 2008

Adam G. Elshaug
Affiliation:
The University of Adelaide and Institute of Medical and Veterinary Science
Janet E. Hiller
Affiliation:
The University of Adelaide and Institute of Medical and Veterinary Science
John R. Moss
Affiliation:
The University of Adelaide

Abstract

Objectives: Many existing healthcare interventions diffused before modern evidence-based standards of clinical- and cost-effectiveness. Disinvestment from ineffective or inappropriately applied practices is growing as a priority for international health policy, both for improved quality of care and sustainability of resource allocation. Australian policy stakeholders were canvassed to assess their perspectives on the challenges and the nature of disinvestment.

Methods: Senior health policy stakeholders from Australia were criterion and snow-ball sampled (to identify opinion leaders). Participants were primed with a potential disinvestment case study and took part in individual semistructured interviews that focused on mechanisms and challenges within health policy to support disinvestment. Interviews were taped and transcribed for thematic analysis. Participant comments were de-identified.

Results: Ten stakeholders were interviewed before saturation was reached. Three primary themes were identified. (i) The current focus on assessment of new and emerging health technologies/practices and lack of attention toward existing practices is due to resource limitations and methodological complexity. Participants considered a parallel model to that of Australia's current assessment process for new medical technologies is best-positioned to facilitate disinvestment. (ii) To advance the disinvestment agenda requires an explicit focus on the potential for cost-savings coupled with improved quality of care. (iii) Support (financial and collaborative) is needed for research advancement in the methodological underpinnings associated with health technology assessment and for disinvestment specifically.

Conclusions: In this exploratory study, stakeholders support the notion that systematic policy approaches to disinvestment will improve equity, efficiency, quality, and safety of health care, as well as sustainability of resource allocation.

Type
GENERAL ESSAYS
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Borowski, HZ, Brehaut, J, Hailey, D. Linking evidence from health technology assessments to policy and decision making: The Alberta model. Int J Technol Assess Health Care. 2007;23:155161.Google Scholar
2. Bridgman, S, Dunn, K, Ducharme, F. Surgery for obstructive sleep apnoea (Cochrane Review). The Cochrane Library. Chichester, UK: John Wiley & Sons, Ltd; 2004.Google Scholar
3. Cooksey, SD. A review of UK health research funding. London: Her Majesty's Treasury; 2006.Google Scholar
4. Denzin, NK, Lincoln, YS, eds. The Sage handbook of qualitative research. Thousand Oaks: Sage Publications; 2005.Google Scholar
5. Draborg, E, Gyrd-Hansen, D. Time-trends in health technology assessments: An analysis of developments in composition of international health technology assessments from 1989 to 2002. Int J Technol Assess Health Care. 2005;21:492498.Google Scholar
6. Elshaug, AG, Moss, JR, Southcott, A, Hiller, JE. An analysis of the evidence-practice continuum: Is surgery for obstructive sleep apnoea contraindicated? J Eval Clin Pract. 2007;13:39.Google Scholar
7. Elshaug AG, Moss JR, Southcott A, Hiller JE. Redefining success in airway surgery for obstructive sleep apnea: A meta analysis and synthesis of the evidence. Sleep. 2007;30:461467.Google Scholar
8. Gafni, A, Birch, S. Incremental cost-effectiveness ratios (ICERs): The silence of the lambda. Soc Sci Med. 2006;62:20912100.Google Scholar
9. Hart, E, Bond, M. Action research for health and social care: A guide to practice. Philadelphia: Open University Press; 1995.Google Scholar
10. Kmietowicz, Z. NICE is to root out ineffective treatments in NHS. BMJ. 2006;333:568, doi:10.1136/bmj.333.7568.568-a.Google Scholar
11. Lehoux, P, Williams-Jones, B. Mapping the integration of social and ethical issues in health technology assessment. Int J Technol Assess Health Care. 2007;23:916.Google Scholar
12. Lehoux, P. The problem of health technology: Policy implications for modern health care systems. New York: Routledge; Taylor and Francis Group; 2006.Google Scholar
13. Medical Services Advisory Committee. Report of a review of the Medical Services Advisory Committee. Canberra: Australian Government Department of Health and Ageing; 2005.Google Scholar
14. Medical Services Advisory Committee. Strengthening evidence-based health care in Australia. Canberra: Australian Government Department of Health and Ageing; 2003.Google Scholar
15. Mitton, C, Patten, S, Donaldson, C, Waldner, H. Priority-setting in health authorities: Moving beyond the barriers. The Calgary experience. Healthc Q. 2005;8:4955.CrossRefGoogle ScholarPubMed
16. Mooney, G. Communitarian claims and community capabilities: Furthering priority setting? Soc Sci Med. 2005;60:247255.CrossRefGoogle ScholarPubMed
17. Morgan SG, McMahon M, Mitton C, et al. Centralized drug review processes in Australia, Canada, New Zealand, and the United kingdom. Health Aff (Millwood). 2006;25:337347.Google Scholar
18. Moss, J. Funding of South Australian public hospitals. Aust Health Rev. 2002;25:156172.CrossRefGoogle ScholarPubMed
19. National Institute for Health and Clinical Excellence. A guide to NICE. London: NHS; 2005.Google Scholar
20. O'Malley, SP. The Australian experiment: The use of evidence based medicine for the reimbursement of surgical and diagnostic procedures (1998-2004). Aust New Zealand Health Policy. 2006;3:3.Google Scholar
21. Phillips, B. Upper airway surgery does not have a major role in the treatment of sleep apnea. J Clin Sleep Med. 2005;1:241245.Google Scholar
22. Pirkis, J, Goldfeld, S, Peacock, S, et al. . Assessing the capacity of the health services research community in Australia and New Zealand. Aust New Zealand Health Policy. 2005;2:4.CrossRefGoogle ScholarPubMed
23. Powell, N. Upper airway surgery does have a major role in the treatment of obstructive sleep apnea: “The tail end of the dog.” J Clin Sleep Med. 2005;1:236240.CrossRefGoogle Scholar
24. SBU The Swedish Council on Technology Assessment in Health Care. Obstructive sleep apnoea syndrome: A systematic literature review: Report of a joint Nordic project. Stockholm: SBU; 2007.Google Scholar
25. Scottish Intercollegiate Guidelines Network (SIGN). Management of obstructive sleep apnoea/hypopnoea syndrome in adults: A national clinical guideline. Edinburgh: Royal College of Physicians; 2003.Google Scholar
26. Smith R. Where is the wisdom . . .? The poverty of medical evidence. BMJ. 1991;303:798799.CrossRefGoogle Scholar
27. Sundaram, S, Bridgman, SA, Lim, J, Lasserson, TJ. Surgery for obstructive sleep apnoea. Cochrane Database Syst Rev 2005: CD001004.CrossRefGoogle Scholar
28. White, KL. Evidence-based medicine. Lancet. 1995;346:837838.CrossRefGoogle ScholarPubMed
29. Wilensky, GR. Developing a center for comparative effectiveness information. Health Aff (Millwood). 2006;25:w572w285.Google Scholar