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Individual responsibility for what? – A conceptual framework for exploring the suitability of private financing in a publicly funded health-care system

Published online by Cambridge University Press:  01 April 2010

Gustav Tinghőg ,
Per Carlsson  and
Carl H. Lyttkens
Gustav Tinghőg*
Affiliation:
Center for Medical Technology Assessment, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
Per Carlsson
Affiliation:
The National Center for Priority Setting in Health Care, Linköping, Sweden
Carl H. Lyttkens
Affiliation:
Department of Economics, School of Economics and Management, Lund University, Lund, Sweden
*
Correspondence to: Gustav Tinghőg, Department of Medical and Health Sciences, Linköping University, SE-581 83 Linköping, Sweden. Email: gustav.tinghog@ihs.liu.se
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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.

Type
Articles
Information
Health Economics, Policy and Law , Volume 5 , Issue 2 , April 2010 , pp. 201 - 223
Copyright
Copyright © Cambridge University Press 2009

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