Disinvestment relates to the process of withdrawing health resources, either partially or completely, from existing healthcare practices (including procedures, devices, diagnostics, programs and pharmaceuticals) that are deemed to deliver no or low health gain for their cost, and are thus not efficient health resource allocations. Released resources can then be reinvested in clinical practices and technologies that deliver safe and effective healthcare for all patients, therefore representing efficient health resource allocation.
The term disinvestment is generally disliked by clinicians and consumers alike due to its negative connotations around funding withdrawal. While other, more acceptable terms include prioritisation, reappraisal, reprioritisation, optimisation, substitutional reinvestment and evidence-based reassessment, the term ‘disinvestment’ is currently used internationally.
It is distinguished between ‘passive disinvestment’ (interventions once common which get outmoded, e.g. surgical interventions) and ‘active disinvestment’: Active disinvestment strategies use a more directed approach to reduce the practice of unnecessary, ineffective, inefficient or harmful interventions. Nationally and internationally, health technology assessment (HTA) programs are now looking to incorporate processes for disinvestment where it is generally understood to mean that low- or no-value healthcare will cease to be funded where there is a lack of safety, clinical and cost effectiveness evidence to support its continued use.