Health Economics and Health Technology Assessment (HEHTA), School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland.
Malaysian Health Technology Assessment Section (MaHTAS), Medical Development Division, Ministry of Health Malaysia, Malaysia, Putrajaya.
Int J Technol Assess Health Care. 2024 Nov 15;40(1):e57. doi: 10.1017/S0266462324004665.
Healthcare disinvestment requires multi-level decision-making, and early stakeholder engagement is essential to facilitate implementation and acceptance. This study aimed to explore the perceptions of Malaysian healthcare stakeholders to disinvestment initiatives as well as identify disinvestment activities in the country.
A cross-sectional online survey was conducted from February to March 2023 among Malaysian healthcare stakeholders involved in resource allocation and decision-making at various levels of governance. Response frequencies were analyzed descriptively and cross-tabulation was performed for specific questions to compare the responses of different groups of stakeholders. For free-text replies, content analysis was used with each verbatim response examined and assigned a theme.
A total of 153 complete responses were analyzed and approximately 37 percent of participants had prior involvement in disinvestment initiatives. Clinical effectiveness and cost-effectiveness ranked as the most important criteria in assessment for disinvestment. Surprisingly, equity was rated the lowest priority despite its crucial role in healthcare decision-making. Almost 90 percent of the respondents concurred that a formal disinvestment framework is necessary and the importance of training for the program's successful implementation. Key obstacles to the adoption of disinvestment include insufficient stakeholder support and political will as well as a lack of expertise in executing the process.
While disinvestment is perceived as a priority for efficient resource allocation in Malaysian healthcare, there is a lack of a systematic framework for its implementation. Future research should prioritize methodological analysis in healthcare disinvestment and strategies for integrating equity considerations in evaluating disinvestment candidates.
医疗保健投资削减需要多层次的决策，早期利益相关者的参与对于促进实施和接受至关重要。本研究旨在探讨马来西亚医疗保健利益相关者对投资削减计划的看法，并确定该国的投资削减活动。
2023 年 2 月至 3 月期间，对参与资源分配和各级治理决策的马来西亚医疗保健利益相关者进行了横断面在线调查。对响应频率进行了描述性分析，并对特定问题进行了交叉制表，以比较不同利益相关者群体的响应。对于自由文本回复，使用内容分析法，对每条逐字回复进行了检查并分配了主题。
共分析了 153 份完整回复，约 37%的参与者之前参与过投资削减计划。临床效果和成本效益被评为评估投资削减的最重要标准。令人惊讶的是，尽管公平在医疗保健决策中起着至关重要的作用，但它被评为优先级最低的因素。近 90%的受访者同意需要制定正式的投资削减框架，并认为对该计划的成功实施进行培训非常重要。采用投资削减的主要障碍包括利益相关者支持和政治意愿不足，以及缺乏执行该过程的专业知识。
虽然投资削减被视为马来西亚医疗保健中提高资源配置效率的优先事项，但缺乏实施该计划的系统框架。未来的研究应优先考虑医疗保健投资削减的方法分析和在评估投资削减候选人时纳入公平考虑的策略。
