Evidence-based disinvestment                                  June 2012       K Roback, J Alwin, A-C Nedlund, L Bernfort  ...
Project aim Investigate on-going disinvestment  initiatives Propose a framework for formal and  active disinvestment in ...
Overview of the Swedish health system                            From: Health Systems                            in Transi...
Overarching aim of the       Swedish health policy “To create social conditions that will  ensure good health, on equal t...
Our work so far Literature search to identify on-going  disinvestment initiatives Preliminary framework based on the  li...
What is disinvestment?The process of withdrawing resources from existing care practices. Stopped or restricted use of hea...
Disinvestment candidate An intervention that is either  harmful, ineffective, obsolete or not cost-  effective. An inter...
Elements in a disinvestmentframework (1-4)1. Scanning for disinvestment candidates.2. Methods and criteria for selecting  ...
Elements in a disinvestmentframework (5-9)5. Public and professional involvement in the   process.6. Transparency of the p...
E1. How to find disinvestmentcandidates? Types of interventions: diagnostic and  screening, treatments, preventive, assis...
E2-4. Selecting candidates –    a two-level procedureSelecting1. candidates for further evaluation2. services to be remove...
E5-6. Public involvement     and transparencyHow open/accessible should the decisions and the workprocesses, decisions and...
E7-8. Implementation1. Implementation of the framework2. Implementation of the disinvestment decisions Implementation int...
E9. Assessment Did the disinvestment give the  anticipated results? Even if implemented properly a  disinvestment decisi...
What to do next      Contact key persons with experiences       from disinvestment      Analysis of texts and interviews...
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Disinvestment. Evidence-based disinvestment.

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Disinvestment. Evidence-based disinvestment.
Division for Health Care Analysis, Dept. of Medical and Health Sciences, Linköping University:
-Center for Medical Technology Assessment (CMT)
-National Center for Priority Setting in Health Care
-Strategic research area ”Implementation & Learning”.
K Roback, J Alwin, A-C Nedlund, L Bernfort

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Disinvestment. Evidence-based disinvestment.

  1. 1. Evidence-based disinvestment June 2012 K Roback, J Alwin, A-C Nedlund, L Bernfort Division for Health Care Analysis, Dept. of Medical and Health Sciences, Linköping University  Center for Medical Technology Assessment (CMT)  National Center for Priority Setting in Health Care  Strategic research area ”Implementation & Learning”____________________________________________________________ Kerstin Roback, Center for Medical Technology Assessment (CMT),Dept. of Medical and Health Sciences (IMH), Linköping University, Sweden
  2. 2. Project aim Investigate on-going disinvestment initiatives Propose a framework for formal and active disinvestment in a Swedish context Describe and exemplify through disinvestment examples__________________________________________________________________ Kerstin Roback, Center for Medical Technology Assessment (CMT), Dept. of Medical and Health Sciences (IMH), Linköping University, Sweden
  3. 3. Overview of the Swedish health system From: Health Systems in Transition, 2012
  4. 4. Overarching aim of the Swedish health policy “To create social conditions that will ensure good health, on equal terms, for the entire population.” Includes an affordable healthcare on equal terms for everyone. But…__________________________________________________________________ Kerstin Roback, Center for Medical Technology Assessment (CMT), Dept. of Medical and Health Sciences (IMH), Linköping University, Sweden
  5. 5. Our work so far Literature search to identify on-going disinvestment initiatives Preliminary framework based on the literature Definitions suitable for our study__________________________________________________________________ Kerstin Roback, Center for Medical Technology Assessment (CMT), Dept. of Medical and Health Sciences (IMH), Linköping University, Sweden
  6. 6. What is disinvestment?The process of withdrawing resources from existing care practices. Stopped or restricted use of healthcare methods that are: - harmful - ineffective - obsolete - or not cost-effective Stopped or restricted public funding for previously funded interventions. (Can involve transfer to out-of-pocket financing.)__________________________________________________________________ Kerstin Roback, Center for Medical Technology Assessment (CMT), Dept. of Medical and Health Sciences (IMH), Linköping University, Sweden
  7. 7. Disinvestment candidate An intervention that is either harmful, ineffective, obsolete or not cost- effective. An intervention that is largely cosmetic or for other reasons accepted for transfer to private funding.Intervention – Indication - Context A candidate for disinvestment must be defined as an intervention-indication pair in a specified context. __________________________________________________________________ Kerstin Roback, Center for Medical Technology Assessment (CMT), Dept. of Medical and Health Sciences (IMH), Linköping University, Sweden
  8. 8. Elements in a disinvestmentframework (1-4)1. Scanning for disinvestment candidates.2. Methods and criteria for selecting candidates for further evaluation.3. Methods and criteria for selecting services to be removed from public funding.4. Overarching principles to guide the disinvestment processes. __________________________________________________________________ Kerstin Roback, Center for Medical Technology Assessment (CMT), Dept. of Medical and Health Sciences (IMH), Linköping University, Sweden
  9. 9. Elements in a disinvestmentframework (5-9)5. Public and professional involvement in the process.6. Transparency of the processes and appeal procedures.7. Implementation of the framework.8. Implementation of disinvestment decisions. Strategies to achieve changes in practice.9. Assessment of the impact of completed disinvestments. __________________________________________________________________ Kerstin Roback, Center for Medical Technology Assessment (CMT), Dept. of Medical and Health Sciences (IMH), Linköping University, Sweden
  10. 10. E1. How to find disinvestmentcandidates? Types of interventions: diagnostic and screening, treatments, preventive, assistive … Medicines, devices, procedures? Scanning methods to identify suitable candidates. Suggestions from public or professions is a possible element. Incentives probably needed __________________________________________________________________ Kerstin Roback, Center for Medical Technology Assessment (CMT), Dept. of Medical and Health Sciences (IMH), Linköping University, Sweden
  11. 11. E2-4. Selecting candidates – a two-level procedureSelecting1. candidates for further evaluation2. services to be removed from public funding Methods and criteria must be specified at both levels Decisionmaking through HTA and Health economics Ethical principles and legitimacy must be considered __________________________________________________________________ Kerstin Roback, Center for Medical Technology Assessment (CMT), Dept. of Medical and Health Sciences (IMH), Linköping University, Sweden
  12. 12. E5-6. Public involvement and transparencyHow open/accessible should the decisions and the workprocesses, decisions and results be? Sweden has a tradition of great openness in authority decisions. When it comes to medical decisions there is still much to do. The process must have some public feedback built in, even though it might slow down the process considerably. The complicated nature of these decisions may make it difficult to inform and engage the citizens.How politically dependent/independent should the decisionsbe? Political involvement might lead to integration of public values in the decisions and to legitimate decisions.
  13. 13. E7-8. Implementation1. Implementation of the framework2. Implementation of the disinvestment decisions Implementation interventions/strategies – a range of methods for achieving a more evidence based healthcare Implementation science, Improvement science, Knowledge to action, Policy implementation…Nordic Conference on Implementation of Evidence-BasedPractice, 5-6 Feb 2013, Linköping, Swedenhttp://www.imh.liu.se/implementering-och-larande/nordic-conference?l=sv__________________________________________________________________ Kerstin Roback, Center for Medical Technology Assessment (CMT), Dept. of Medical and Health Sciences (IMH), Linköping University, Sweden
  14. 14. E9. Assessment Did the disinvestment give the anticipated results? Even if implemented properly a disinvestment decision may have unexpected effects. “…good health, on equal terms, for the entire population.”__________________________________________________________________ Kerstin Roback, Center for Medical Technology Assessment (CMT), Dept. of Medical and Health Sciences (IMH), Linköping University, Sweden
  15. 15. What to do next  Contact key persons with experiences from disinvestment  Analysis of texts and interviews to evaluate what may work  Finally – presentation of the framework and suggested use at the county council levelInterested persons are welcome to discuss disinvestmentissues with us and/or become our informants.Please contact: kerstin.roback@liu.se __________________________________________________________________ Kerstin Roback, Center for Medical Technology Assessment (CMT), Dept. of Medical and Health Sciences (IMH), Linköping University, Sweden

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