title: [In healthcare, more or less, less is more: notes on healthcare disinvestment].
abstract: OBJECTIVE
  Beyond the current economic crisis, the Spanish National Health System (SNHS) has a problem of long-term sustainability that has its roots in changes in the morbidity patterns with the onset of chronic diseases and the acceleration of technological change, and with the rapid incorporation of new and expensive technologies. The aim of this paper is to explore the role of low value technology disinvestment as a strategy for SNHS sustainability.
  
  
  METHODS
  Narrative review and discussion of the relevant features of disinvestment, and disinvestment strategies in several countries.
  
  
  RESULTS
  Disinvestment is an explicit process of (partially or completely) withdrawing drugs, devices, practices or procedures with low or questionable clinical value. Very dissimilar healthcare systems such as those in Australia, New Zealand, United Kingdom or United States have launched disinvestment strategies adapted to their different contexts, while in Spain there remains a degree of reluctance to incorporate explicit mechanisms for decision-making on incorporation/disinvestment of health technologies with regard to the SNHS.
  
  
  CONCLUSIONS
  Low value technology disinvestment is complex. Many technologies are only candidates for partial withdrawal, or its value is controversial and, in addition, there are psychological and sociological barriers to disinvestment. Implementation of these strategies requires commitment from professionals and health authorities and cooperation from patients and citizens, which in turn should be carefully managed.
authors.forename: S
authors.initials: S
authors.lastname: Peiró
mesh_terms: D003362:Cost-Benefit Analysis; D015276:Health Care Rationing / Q000458:organization & administration*; D006291:Health Policy; D015397:Program Evaluation; D013030:Spain; D013222:State Medicine / Q000458:organization & administration*; D013673:Technology Assessment, Biomedical