Embrett Mark, Randall Glen E, Lavis John N, Dion Michelle L
Faculty of Health, School of Nursing, Dalhouise University, 5869 University Avenue, PO BOX 15000, Halifax, Nova Scotia, B3H 4R2, Canada.
St. Francis Xavier University, 4130 University Avenue, Antigonish, Nova Scotia, B2G2W5, Canada.
Health Res Policy Syst. 2020 Oct 28;18(1):123. doi: 10.1186/s12961-020-00630-9.
Terms used to describe government-led resource withdrawal from ineffective and unsafe medical services, including 'rationing' and 'disinvestment', have tended to be used interchangeably, despite having distinct characteristics. This lack of descriptive precision for arguably distinct terms contributes to the obscurity that hinders effective communication and the achievement of evidence-based decision-making. The objectives of this study are to (1) identify the various terms used to describe resource withdrawal and (2) propose definitions for the key or foundational terms, which includes a clear description of the unique characteristics of each.
This is a systematic qualitative synthesis of characteristics and terms found through a search of the academic and grey literature. This approach involved identifying commonly used resource withdrawal terms, extracting data about resource withdrawal characteristics associated with each term and conducting a comparative analysis by categorising elements as antecedents, attributes or outcomes.
Findings from an analysis of 106 documents demonstrated that terms used to describe resource withdrawal are inconsistently defined and applied. The characteristics associated with these terms, mainly antecedents and attributes, are used interchangeably by many authors but are differentiated by others. Our analysis resulted in the development of a framework that organises these characteristics to demonstrate the unique attributes associated with each term. To enhance precision, these terms were classified as either policy options or patient health outcomes and refined definitions for rationing and disinvestment were developed. Rationing was defined as resource withdrawal that denies, on average, patient health benefits. Disinvestment was defined as resource withdrawal that results in, on average, improved or no change in health benefits.
Agreement on the definition of various resource withdrawal terms and their key characteristics is required for transparent government decision-making regarding medical service withdrawal. This systematic qualitative synthesis presents the proposed definitions of resource withdrawal terms that will promote consistency, benefit public policy dialogue and enhance the policy-making process for health systems.
用于描述政府主导的从无效和不安全医疗服务中撤资的术语，包括“配给”和“撤资”，尽管具有不同的特征，但往往被交替使用。对于这些可以说是不同的术语缺乏精确描述，导致了阻碍有效沟通和基于证据的决策达成的模糊性。本研究的目的是：（1）识别用于描述撤资的各种术语；（2）为关键或基础术语提出定义，其中包括对每个术语独特特征的清晰描述。
这是一项通过检索学术文献和灰色文献对撤资特征和术语进行的系统定性综合研究。该方法包括识别常用的撤资术语，提取与每个术语相关的撤资特征数据，并通过将要素分类为前因、属性或结果进行比较分析。
对106份文件的分析结果表明，用于描述撤资的术语定义和应用不一致。与这些术语相关的特征，主要是前因和属性，许多作者交替使用，但也有其他人对其进行了区分。我们的分析产生了一个框架，该框架组织这些特征以展示与每个术语相关的独特属性。为了提高精确性，这些术语被分类为政策选项或患者健康结果，并为配给和撤资制定了更精确的定义。配给被定义为平均而言会剥夺患者健康益处的撤资。撤资被定义为平均而言会导致健康益处改善或无变化的撤资。
对于政府在医疗服务撤资方面的透明决策，需要就各种撤资术语的定义及其关键特征达成一致。这种系统的定性综合研究提出了撤资术语的建议定义，这将促进一致性，有利于公共政策对话，并加强卫生系统的决策过程。
