Societal views in the Netherlands on active disinvestment of publicly funded healthcare interventions

https://doi.org/10.1016/j.socscimed.2021.113708Get rights and content
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Highlights

  • Q-methodology was used to discern the societal viewpoints on active disinvestment.

  • Four heterogeneous viewpoints on active disinvestment were identified.

  • Heterogeneity between viewpoints may explain difficulties to obtain public support.

  • To increase public support, policymakers should focus on non-necessary healthcare.

  • To increase public support, disinvestment decision-making should be transparent.

Abstract

Objectives

To obtain public support for the active disinvestment (i.e. policy decision to stop reimbursement) of healthcare interventions, it is important to have insight in what the public thinks about disinvestment and which considerations they find relevant in this context. Currently, evidence on relevant considerations in the disinvestment context is limited. Therefore, this study aimed to explore the societal views in the Netherlands on the active disinvestment of healthcare interventions and obtain insight into the considerations that are relevant for those holding the different views.

Methods

A Q-methodology study was conducted among a purposively selected sample of citizens (n = 43). Data were collected in June and July 2019. Participants individually ranked a set of 43 statements broadly covering the issues that participants could consider relevant in the disinvestment context, from ‘least agree’ to ‘most agree’. Qualitative feedback on the statement ranking was collected from each participant using a questionnaire. Principal component analysis followed by oblimin rotation was used to identify clusters of participants with similar statement rankings. These clusters/factors were interpreted as distinct viewpoints using the factor arrays and qualitative questionnaire responses of participants.

Results

Four viewpoints were identified. People holding viewpoint I believe that reimbursement of necessary healthcare should be maintained, irrespective of its costs. People holding viewpoint II agree with viewpoint I, although they believe that necessity should be objectively determined. People holding viewpoint III think that unnecessary, ineffective and inefficient healthcare should be disinvested. People holding viewpoint IV, consider it most important that disinvestment decision-making processes are transparent and consistent.

Conclusion

Insight in the distinct viewpoints identified in this study contributes to a better understanding of why it has been considered difficult to obtain public support for disinvestment of healthcare interventions, and can help policymakers to change their approach to disinvestment to increase public support.

Keywords

Disinvestment
Health technology reassessment
Societal viewpoints
Considerations
Reimbursement
Q-methodology
Mixed methods
The Netherlands

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