Stakeholders' perspectives on disinvestment of low-value healthcare interventions and practices in Malaysia: an online survey

Objectives:Healthcare disinvestment requires multi-level decision-making, and early stake-holder engagement is essential to facilitate implementation and acceptance. This study aimed toexplore the perceptions of Malaysian healthcare stakeholders to disinvestment initiatives as wellas identify disinvestment activities in the country. Methods:A cross-sectional online survey was conducted from February to March 2023 amongMalaysian healthcare stakeholders involved in resource allocation and decision-making atvarious levels of governance. Response frequencies were analyzed descriptively and cross-tabulation was performed for specific questions to compare the responses of different groupsof stakeholders. For free-text replies, content analysis was used with each verbatim responseexamined and assigned a theme. Results:A total of 153 complete responses were analyzed and approximately 37 percent ofparticipants had prior involvement in disinvestment initiatives. Clinical effectiveness and cost-effectiveness ranked as the most important criteria in assessment for disinvestment. Surpris-ingly, equity was rated the lowest priority despite its crucial role in healthcare decision-making.Almost 90 percent of the respondents concurred that a formal disinvestment framework isnecessary and the importance of training for the program's successful implementation. Keyobstacles to the adoption of disinvestment include insufficient stakeholder support and politicalwill as well as a lack of expertise in executing the process. Conclusions:While disinvestment is perceived as a priority for efficient resource allocation inMalaysian healthcare, there is a lack of a systematic framework for its implementation. Futureresearch should prioritize methodological analysis in healthcare disinvestment and strategies forintegrating equity considerations in evaluating disinvestment candidates.