[Reinvestment in health: fundamentals, clarifications, experiences and perspectives]

During the economic crisis, the pressure to reduce health services expenditure as an isolated measure is greater than measures intended to increase the efficiency of these services. Information, methods and experiences to improve health outcomes with limited resources are available and a number of countries have been applying measures to achieve this goal. One of these measures is disinvestment. Given that this tactic is necessary but also intricate, allergenic and confusing, this article tries to clarify its meaning, place it in its correct context, and describe the methods and criteria used to identify and prioritize candidate medical technologies for disinvestment. The experiences of Spain, New Zealand, Australia, Canada, the United Kingdom and Italy in this endeavor are reviewed, as well as the obstacles faced by these countries when disinvesting and their mid-term perspectives. Ignorance does not excuse its application, regardless of whether there is a crisis or not. Efforts to improve social efficiency are a permanent obligation of the national health system.