Disinvesting from Low-Value Health Technologies in Low- and Middle-Income Countries: Between a Solution to the Current Fiscal Crises and a Costly Mirage?

In this policy paper we summarise what is known about healthcare disinvestment and outline documented experiences in low- and middle-income countries (LMICs) to draw insights on what has worked, to what extent, and under what conditions. We reviewed the published literature on documented experiences of attempted healthcare disinvestment in LMICs. We identified two common scenarios when disinvestment initiatives were attempted, namely “one-off” and “systematic” initiatives, and characterised them in terms of objectives, resources and political will. We found four documented examples of one-off disinvestment initiatives—Iran, Malaysia, Romania, and Vietnam, two documented examples of systematic disinvestment initiatives by health technology assessment (HTA) agencies in LMICs—Brazil and China, as well as a range of countries like Thailand, India, and Ghana that carry out systematic disinvestment through routine HTA processes. We conclude that disinvestment is costly, time-consuming, and rarely as successful as policymakers intend. Key considerations to improve the chances of success include whether strong pre-existing health prioritisation systems exist (such as an HTA agency) and whether the design of initiatives are tightly matched to the level of political will, the policy objective, and available resources.