Exploring Disinvestment Desicions In The NHS Via Health Economics

OBJECTIVES: A core assumption across Health Economics analyses is that disinvestments across the wider healthcare system would free up resources to enable maximum health outcome and economic advantage. However, this is seldom explicitly dealt with. This project aims to explore methodological alternatives to the currently value-demonstration paradigm in the NHS across the UK that could adequately address the assumption of systemic disinvestment. METHODS: A comprehensive review of existing approaches was conducted via PubMed, Google Scholar and grey literature. Critical appraisal of the gaps in the existing approaches was conducted and case studies identified. Next, actionable methodological suggestions for the current NHS environment were identified and research recommendations made. UK NHS was the focus. RESULTS: Structured searches resulted in 140+ hits on PubMed and 6000+ hits on Google Scholar and grey literature. 25 articles were selected based on title and abstract screening. Even newer approaches like Socio-Technical Allocation of Resources (STAR) appear not to focus deeply on disinvestments as a key part of the complex systemic solution matrix. Early discussions on relevant approaches were from the WHO regarding Generalised Cost Effectiveness (GCEA) methods. More recent papers have focused on options like the Programme Budgeting Marginal Analysis (PBMA) and Sustainability in Healthcare by Allocating Resource Effectively (SHARE). CONCLUSIONS: A key finding was the lack of focus on disinvestment in the UK in academic literature. Techniques like GCEA and Cost Minimisation Analyses (CMA) have been around for long; however, have not generally been reported or evaluated for disinvestment decisions. Newer techniques like PBMA and SHARE show promise. The topic of disinvestment requires more use, research, and validation.