title: Individual responsibility for healthcare financing: application of an analytical framework exploring the suitability of private financing of assistive devices.
abstract: OBJECTIVE
  To operationalise and apply a conceptual framework for exploring when health services contain characteristics that facilitate individuals' ability to take individual responsibility for health care through out-of-pocket payment. In addition, we investigate if the levels of out-of-pocket payment for assistive devices (ADs) in Sweden are in line with the proposed framework.
  
  
  METHODS
  Focus groups were used to operationalise the core concepts of sufficient knowledge, individual autonomy, positive externalities, sufficient demand, affordability, and lifestyle enhancement into a measurable and replicable rationing tool. A selection of 28 ADs were graded separately as having high, medium, or low suitability for private financing according to the measurement scale provided through the operationalised framework. To investigate the actual level of private financing, a questionnaire about the level of out-of-pocket payment for the specific ADs was administered to county councils in Sweden.
  
  
  RESULTS
  Concepts were operationalised into three levels indicating possible suitability for private financing. Responses to the questionnaire indicate that financing of ADs in Sweden varies across county councils as regards co-payment, full payment, discretionary payment for certain healthcare consumer groups, and full reimbursement. According to the framework, ADs commonly funded privately were generally considered to be more suitable for private financing.
  
  
  CONCLUSIONS
  Sufficient knowledge, individual autonomy, and sufficient demand did not appear to influence why certain ADs were financed out-of-pocket. The level of positive externalities, affordability, and lifestyle enhancement appeared to be somewhat higher for ADs that were financed out-of-pocket, but the differences were small. Affordability seemed to be the most influential concept.
authors.affiliation: Department of Management and Engineering, Linköping University, Sweden. gustav.tinghog@liu.se
authors.forename: Gustav
authors.initials: G
authors.lastname: Tinghög
authors.forename: Per
authors.initials: P
authors.lastname: Carlsson
mesh_terms: D005382:Financing, Personal / Q000706:statistics & numerical data; D017144:Focus Groups; D015276:Health Care Rationing; D061889:Healthcare Financing; D006801:Humans; D017059:Models, Econometric; D026684:Personal Autonomy; D017149:Private Sector / Q000191:economics*; D017150:Public Sector / Q000191:economics; D012656:Self-Help Devices / Q000191:economics*; D012941:Social Responsibility; D013548:Sweden