title: Individual responsibility for what? - a conceptual framework for exploring the suitability of private financing in a publicly funded health-care system.
abstract: Policymakers in publicly funded health-care systems are frequently required to make intricate decisions on which health-care services to include or exclude from the basic health-care package. Although it seems likely that the concept of individual responsibility is an essential feature of such decisions, it is rarely explicitly articulated or evaluated in health policy. This paper presents a tentative conceptual framework for exploring when health-care services contain characteristics that facilitate individual responsibility through private financing. Six attributes for exploring the suitability of private financing for specific health-care commodities are identified: (i) it should enable individuals to value the need and quality both before and after utilization; (ii) it should be targeted toward individuals with a reasonable level of individual autonomy; (iii) it should be associated with low levels of positive externalities; (iv) it should be associated with a demand sufficient to generate a private market; (v) it should be associated with payments affordable for most individuals; and finally, (vi) it should be associated with 'lifestyle enhancements' rather than 'medical necessities'. The tentative framework enables exploration of individual responsibility connected to health care as a heterogeneous group of commodities, and allows policymakers to make decisions on rationing by design rather than default.
authors.affiliation: aCenter for Medical Technology Assessment, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. gustav.tinghog@ihs.liu.se
authors.forename: Gustav
authors.initials: G
authors.lastname: Tinghog
authors.forename: Per
authors.initials: P
authors.lastname: Carlsson
authors.forename: Carl H
authors.initials: CH
authors.lastname: Lyttkens
mesh_terms: D003132:Commerce; D003657:Decision Making; D003695:Delivery of Health Care / Q000191:economics* / Q000458:organization & administration; D018166:Health Care Reform / Q000191:economics*; D005102:Health Expenditures; D006291:Health Policy / Q000191:economics*; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D026684:Personal Autonomy; D017149:Private Sector / Q000191:economics*; D012941:Social Responsibility; D012946:Social Welfare; D013548:Sweden