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UBC Theses and Dissertations

The development of a disinvestment framework to guide resource allocation decisions in health service delivery organizations Schmidt, Diane E.


Objective: Within publicly funded health care, there is an urgent need to reduce spending while maximizing benefits; however, processes to guide so-called disinvestment decisions are lacking. The purpose of this research is to develop a framework that will provide decision-makers with a more equitable approach to meeting budgetary constraints than current practices. Methods: Through a systematic review of the health care literature and a scoping review of the public sector and business literatures, a knowledge synthesis of disinvestment approaches was created, including analyses of current strategies and the modeling of appropriate processes. From this synthesis, a disinvestment framework has been developed. In collaboration with Chief Financial Officers from across Western Canada and an external reference group comprised of international researchers, the framework has been critiqued in keeping with current resource allocation practices. Results: Evidence from the two reviews revealed that while budgetary cutbacks are experienced across government, non-profit and the private sector, very few processes have been developed to identify and implement disinvestment options. In cases of budget re-allocation, program budgeting and marginal analysis (PBMA) was the most relevant framework described. However, PBMA fails to address stand-alone disinvestment requirements. Within the public sector and business literatures, cutback management and policy termination research offered strategies to mitigate barriers and facilitate implementation, however, details were absent. Drawing elements from the approaches identified in the reviews, and in collaboration with decision-makers and other researchers, a seven-step disinvestment framework was developed that can be incorporated into on-going priority setting practices or applied as a stand-alone activity. Conclusion: This work addresses a critical knowledge gap in how health service organizations approach disinvestment activities. The proposed framework provides detailed steps to equip health care decision makers with a clear and defined disinvestment process. Such a process will help to ensure limited funds are allocated based on evidence rather than across-the-board cuts or historical practices.

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