The environment of severe cost containment has led to the active search of "internal sustainability'' of health systems; the disinvestment in all non-value added services is one of the tools used. This article provides the taxonomy to identify ineffective, unsafe, unnecessary, unsuccessful, unkind and unwise care practices and discusses their implications in relation to patients ordered according to their severity, as well as the expected health gains of the intervention. Finally, the feasibility of those disinvestment policies is analysed according to macro-, middle, and micro-management scenarios. (C) 2012 SECA. Published by Elsevier Espana, S.L. All rights reserved.
