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Can We (Ethically) Disinvest from Healthcare Interventions?

By Jessica Pace and Wendy Lipworth, Sydney Health Ethics

The withdrawal or reduction of a medication or surgical technique can make healthcare safer, cheaper and more effective. However, practical and ethical challenges mean that we can't solely rely on this to ensure a fair distribution of healthcare.

The full text of this article can be purchased from Informit.

Systems that fund healthcare, such as Australia’s Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Schedule (MBS), face two key challenges. First, health technologies are expensive, and are getting more so. Second, people often want fast access to new technologies, sometimes even when evidence of safety, effectiveness and value for money is lacking.

One way to respond to these challenges is ‘disinvestment’: removing a health technology from the market or restricting its use to situations that offer best value for money. By disinvesting from ‘low value’ technologies (i.e. those that offer little or no net benefit), we free up resources to use for safer, more effective or more cost-effective technologies.

Countries around the world have begun to look for ways of systematically disinvesting from low value health care. You may, for example, have heard of the Choosing Wisely campaign, which aims to encourage a reduction in wasteful medical tests, procedures and treatments. In Australia, this campaign has identified and led to recommendations on issues such as the routine use of opioid-based painkillers in patients who don’t actually need these addictive drugs.

One of the supposed advantages of disinvestment is that it allows interventions to be “conditionally approved” by regulators and funders even if the necessary evidence is not yet known. In...

The full text of this article can be purchased from Informit.