Abstract
Background: Terms used to describe government-led resource withdrawal from ineffective and unsafe medical
services, including ‘rationing’ and ‘disinvestment’, have tended to be used interchangeably, despite having distinct
characteristics. This lack of descriptive precision for arguably distinct terms contributes to the obscurity that hinders
effective communication and the achievement of evidence-based decision-making. The objectives of this study are
to (1) identify the various terms used to describe resource withdrawal and (2) propose definitions for the key or
foundational terms, which includes a clear description of the unique characteristics of each.
Methods: This is a systematic qualitative synthesis of characteristics and terms found through a search of the academic
and grey literature. This approach involved identifying commonly used resource withdrawal terms, extracting data about
resource withdrawal characteristics associated with each term and conducting a comparative analysis by categorising
elements as antecedents, attributes or outcomes.
Results: Findings from an analysis of 106 documents demonstrated that terms used to describe resource withdrawal are
inconsistently defined and applied. The characteristics associated with these terms, mainly antecedents and attributes,
are used interchangeably by many authors but are differentiated by others. Our analysis resulted in the development of
a framework that organises these characteristics to demonstrate the unique attributes associated with each term. To
enhance precision, these terms were classified as either policy options or patient health outcomes and refined
definitions for rationing and disinvestment were developed. Rationing was defined as resource withdrawal that denies,
on average, patient health benefits. Disinvestment was defined as resource withdrawal that results in, on average,
improved or no change in health benefits.
Conclusion: Agreement on the definition of various resource withdrawal terms and their key characteristics is required
for transparent government decision-making regarding medical service withdrawal. This systematic qualitative synthesis
presents the proposed definitions of resource withdrawal terms that will promote consistency, benefit public policy
dialogue and enhance the policy-making process for health systems.