Hostname: page-component-76d6cb85b7-5qg8f Total loading time: 0 Render date: 2026-07-12T07:56:46.477Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access Rights & Permissions [Opens in a new window]

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

Information

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

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.)

Article purchase

Temporarily unavailable

References

REFERENCES

1.CIHI. Canadian Institute for Health Information (CIHI) [Internet]. Ottawa: The Institute; 2011. Healthcare spending to reach $192 billion this year; 2010. http://www.cihi.ca/cihi-ext-portal/internet/en/document/spending+and+health+workforce/spending/release_28oct10 (accessed November 24, 2011).Google Scholar
2.Conference Board of Canada. Understanding health care cost drivers and escalators [Internet]. Ottawa: The Board; 2004. http://www.health.alberta.ca/documents/Health-Costs-Drivers-CBC-2004.pdf (accessed November 24, 2011).Google Scholar
3.Elshaug, AG, Watt, AM, Moss, JR, Hiller, JE.Policy perspectives on the obsolescence of health technologies in Canada: A discussion paper [Internet]. Ottawa: CADTH; 2009. (Policy Forum). [cited 2011 Nov 24]. http://www.cadth.ca/en/policy-forum/discussion-papers/policy-perspectives-on-the-obsolescence-of-health (accessed November 24, 2011).Google Scholar
4.Elshaug, AG, Moss, JR, Littlejohns, P, et al.Identifying existing health care services that do not provide value for money. Med J Aust [Internet]. 2009;190:269–273. https://www.mja.com.au/journal/2009/190/5/identifying-existing-health-care-services-do-not-provide-value-money (accessed October 19, 2011).CrossRefGoogle Scholar
5.Crockett, A, Cranston, J, Moss, J, et al.Program budgeting and marginal analysis: A case study in chronic airflow limitation. Aust Health Rev. 1999;22:65–77.CrossRefGoogle ScholarPubMed
6.Medical Services Advisory Committee (MSAC). Welcome to the Medical Services Advisory Committee [Internet]. Canberra ACT: Commonwealth of Australia; 2011. Review of kyphoplasty for the treatment of vertebral compression fracture and review of interim funded service: Vertebroplasty for the treatment of vertebral compression fracture; 2011. http://www.msac.gov.au/internet/msac/publishing.nsf/Content/27.1–1 (accessed November 24, 2011).Google Scholar
7.Medical Services Advisory Committee (MSAC). Welcome to the Medical Services Advisory Committee [Internet]. Canberra ACT: Commonwealth of Australia; 2011. Review of interim funded service: Artificial intervertebral disc replacement - lumbar; 2011. http://www.msac.gov.au/internet/msac/publishing.nsf/Content/1090.1 (accessed November 24, 2011).Google Scholar
8.Carter, R, Stone, C, Vos, T, et al.Trial of Program Budgeting and Marginal Analysis (PBMA) to assist cancer control planning in Australia. Melbourne: Centre for Health Program Evaluation; 2000. (PBMA Series No 5: Summary Report).Google Scholar
9.Mitton, C, Dionne, F, Damji, R, Campbell, D, Bryan, S.Difficult decisions in times of constraint: Criteria based resource allocation in the Vancouver Coastal Health Authority. BMC Health Serv Res [Internet]. 2011;11:169. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3155484 (accessed October 19, 2011).Google Scholar
10.Mitton, C, Donaldson, C, Shellian, B, Pagenkopf, C.Priority setting in a Canadian surgical department: A case study using program budgeting and marginal analysis. Can J Surg. 2003;46:23–29.Google Scholar
11.Spenceley, S, Halma, L.Improving surgical service utilization - An application of program budgeting and marginal analysis. Ambul Surg. 2002;10:37–44.CrossRefGoogle Scholar
12.Urquhart, B, Mitton, C, Peacock, S.Introducing priority setting and resource allocation in home and community care programs. J Health Serv Res Policy [Internet]. 2008;13(Suppl 1):41–45. http://jhsrp.rsmjournals.com/content/13/suppl_1/41.full.pdf+html (accessed October 19, 2011).Google Scholar
13.Twaddle, S, Walker, A.Programme budgeting and marginal analysis: Application within programmes to assist purchasing in Greater Glasgow Health Board. Health Policy. 1995;33:91–105.CrossRefGoogle ScholarPubMed
14.Ball, H, Kemp, L, Fordham, R.Road testing programme budgeting and marginal analysis: Norfolk Mental Health pilot project. The Psychiatrist [Internet]. 2009 [cited 2011 Oct 19];33(4):141–4. http://pb.rcpsych.org/content/33/4/141.full.pdf+html (accessed October 19, 2011).Google Scholar
15.Ratcliffe, J, Donaldson, C, Macphee, S.Programme budgeting and marginal analysis: A case study of maternity services. J Public Health Med [Internet]. 1996;18:175–182. http://jpubhealth.oxfordjournals.org/content/18/2/175.full.pdf (accessed October 19, 2011).Google Scholar
16.Ruta, DA, Donaldson, C, Gilray, I.Economics, public health and health care purchasing: The Tayside experience of programme budgeting and marginal analysis. J Health Serv Res Policy. 1996;1:185–193.CrossRefGoogle ScholarPubMed
17.Bohmer, P, Pain, C, Watt, A, Abernethy, P, Sceats, J.Maximising health gain within available resources in the New Zealand public health system. Health Policy. 2001;55:37–50.CrossRefGoogle ScholarPubMed
18.Lindström, H, Waldau, S.Ethically acceptable prioritisation of childless couples and treatment rationing: “Accountability for reasonableness”. Eur J Obstet Gynecol Reprod Biol. 2008;139:176–186.CrossRefGoogle ScholarPubMed
19.INAHTA (International Network of Agencies for Health Technology Assessment). International network of agencies for HTA [Internet]. Stockholm (Sweden): INAHTA; 2012. http://www.inahta.net/ (accessed June 28, 2012).Google Scholar
20.Kapiriri, L, Norheim, OF, Martin, DK.Priority setting at the micro-, meso- and macro-levels in Canada, Norway and Uganda. Health Policy. 2007;82:78–94.CrossRefGoogle ScholarPubMed
21.Mortimer, D.Reorienting programme budgeting and marginal analysis (PBMA) towards disinvestment. BMC Health Serv Res [Internet]. 2010;10:288. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2964694 (accessed October 19, 2011).Google Scholar
22.Mitton, C, Donaldson, C.Health care priority setting: Principles, practice and challenges. Cost Eff Resour Alloc [Internet]. 2004;2:3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC411060/pdf/1478–7547-2–3.pdf (accessed October 19, 2011).Google Scholar
23.Dionne, F, Mitton, C, Smith, N, Donaldson, C.Evaluation of the impact of program budgeting and marginal analysis in Vancouver Island Health Authority. J Health Serv Res Policy [Internet]. 2009;14:234–242. http://jhsrp.rsmjournals.com/content/14/4/234.full.pdf+html (accessed October 19, 2011).Google Scholar
24.Tsourapas, A, Frew, E.Evaluating ‘success’ in programme budgeting and marginal analysis: A literature review. J Health Serv Res Policy [Internet]. 2011;16(3):177–83. http://jhsrp.rsmjournals.com/content/16/3/177.full.pdf+html (accessed October 19, 2011).Google Scholar
25.Elshaug, AG, Watt, AM, Mundy, L, Willis, CD.Over 150 potentially low-value health care practices: An Australian study. Med J Aust. 2012 Nov 19;197:556–560.CrossRefGoogle ScholarPubMed
Supplementary material: File

Polisena et al. supplementary material

Supplementary table 1

Download Polisena et al. supplementary material(File)
File 344.6 KB