What influences the outcome of active disinvestment processes in healthcare? A qualitative interview study on five recent cases of active disinvestment

Abstract Background Recent attempts of active disinvestment (i.e. withdrawal reimbursement by means a policy decision) reimbursed healthcare interventions in the Netherlands have differed their outcome: some were successful, with actually being disinvested. Other terminated at point, implying unsuccessful disinvestment. This study aimed to obtain insight into recent processes, and explore what aspects affect outcome. Methods Semi-structured interviews conducted from January December 2018 stakeholders (e.g. patients, policymakers, physicians) who involved process five cases for which full or partial was considered between 2007 2017: benzodiazepines, medication Fabry disease, quit smoking programme, psychoanalytic therapy maternity care assistance. These covered both that eventually disinvested maintained after consideration. Interviews transcribed verbatim, double coded analyzed using thematic analysis. Results The 37 showed support stakeholders, especially providers strongly affected outcome process. Furthermore, institutional role as legitimized Dutch health insurance system, financial interests maintaining discontinuing reimbursement, possibility relieve consequences current patients well. A poor organization patient groups may make it difficult exert pressure, contribute successful No evidence found consistent formal package criteria effectiveness, cost-effectiveness, necessity feasibility) processes. Conclusions Contextual factors well are important determinants results provide processes determinants, guidance policymakers potentially more approach future