Abstract
BackgroundTerms used to describe government-led resource withdrawal from ineffective and unsafe medical services, including ‘rationing’ and ‘disinvestment’, have tended to be used interchangeably, despite having distinct characteristics. This lack of descriptive precision for arguably distinct terms contributes to the obscurity that hinders effective communication and the achievement of evidence-based decision-making. The objectives of this study are to (1) identify the various terms used to describe resource withdrawal and (2) propose definitions for the key or foundational terms, which includes a clear description of the unique characteristics of each.MethodsThis is a systematic qualitative synthesis of characteristics and terms found through a search of the academic and grey literature. This approach involved identifying commonly used resource withdrawal terms, extracting data about resource withdrawal characteristics associated with each term and conducting a comparative analysis by categorising elements as antecedents, attributes or outcomes.ResultsFindings from an analysis of 106 documents demonstrated that terms used to describe resource withdrawal are inconsistently defined and applied. The characteristics associated with these terms, mainly antecedents and attributes, are used interchangeably by many authors but are differentiated by others. Our analysis resulted in the development of a framework that organises these characteristics to demonstrate the unique attributes associated with each term. To enhance precision, these terms were classified as either policy options or patient health outcomes and refined definitions for rationing and disinvestment were developed. Rationing was defined as resource withdrawal that denies, on average, patient health benefits. Disinvestment was defined as resource withdrawal that results in, on average, improved or no change in health benefits.ConclusionAgreement on the definition of various resource withdrawal terms and their key characteristics is required for transparent government decision-making regarding medical service withdrawal. This systematic qualitative synthesis presents the proposed definitions of resource withdrawal terms that will promote consistency, benefit public policy dialogue and enhance the policy-making process for health systems.
Highlights
Introduction of a new technologyNew technologies that were adopted into benefits packages for publicly insured services, whether more cost-effective or not, were viewed as an important prompt to replace existing technologies
The process began with antecedents that have been identified to logically precede resource withdrawal, which was followed by the various processes that governments have used to identify medical services and the policy options to withdraw resources
This study addressed the confusion between the use of various terms describing government-led resource withdrawal and the characteristics associated with those terms found in the academic and grey literature
Summary
Introduction of a new technologyNew technologies that were adopted into benefits packages for publicly insured services, whether more cost-effective or not, were viewed as an important prompt to replace existing technologies. Terms used to describe government-led resource withdrawal from ineffective and unsafe medical services, including ‘rationing’ and ‘disinvestment’, have tended to be used interchangeably, despite having distinct characteristics. This lack of descriptive precision for arguably distinct terms contributes to the obscurity that hinders effective communication and the achievement of evidence-based decision-making. Terms used to describe government-led resource withdrawal from ineffective and unsafe medical services, including ‘rationing’ and ‘disinvestment’, tend to be used interchangeably, despite their distinct characteristics This lack of descriptive precision for distinct terms contributes to a lack of clarity that hinders effective communication and achieving evidencebased decision-making. Clarification of terminology is necessary to describe the situations in which resource withdrawal occurs, to understand which factors influence resource withdrawal outcomes, and to communicate resource withdrawal information accurately [7]
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