Table 1 Example of the overlap between the definitions of disinvestment and rationing

A process of selecting and reducing/removing select medical services

The formal processes and mechanisms that are used to reduce or discontinue the use of selected procedures and treatments [4]

Explicit decisions about the amounts and types of resources to be made available, eligible populations, and specific rules for allocation [54]

A process of selecting and reducing/removing only harmful/inefficient or ineffective medical services

The cessation or restriction of potentially harmful, clinically ineffective or cost inefficient practices [23]

Taking resources from services that provide little or no value [66]

The elimination or reduction in the provision of a service based on evidence of low value [67]

Limiting the choice of services to provide in an area with scarce resources; choice is decided on effectiveness, equity and patient choice [68]

A process of withdrawing resources and reallocating them to medical services of higher value

The processes of (partially or completely) withdrawing health resources from any existing healthcare practices, procedures, technologies or pharmaceuticals that are deemed to deliver little or no health gain for their cost and are thus not efficient health resource allocations; within this is the view to reallocation or reinvestment towards technologies, practices and programmes with greater demonstrated (cost-)effectiveness [9, 21, 29, 41, 52, 69, 70];

A priority-setting activity where resources are removed from the service such that other more effective ones are prioritised [71]

Restriction of medical services to only those who benefit

Funding decision to restrict the use of a service to those who may benefit the most [47]

Restriction of services to those who have a higher perceived benefit [72]