aCenter for Medical Technology Assessment, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Health Econ Policy Law. 2010 Apr;5(2):201-23. doi: 10.1017/S174413310999017X. Epub 2009 Sep 2.
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.
在公共资助的医疗保健系统中，政策制定者经常需要做出复杂的决策，决定将哪些医疗保健服务纳入或排除在基本医疗保健套餐之外。尽管个人责任的概念似乎是此类决策的一个基本特征，但在卫生政策中很少明确阐述或评估。本文提出了一个初步的概念框架，用于探讨何时医疗保健服务通过私人融资具有促进个人责任的特征。确定了探索私人融资是否适合特定医疗保健商品的六个属性：（i）它应该使个人能够在使用前后评估需求和质量；（ii）它应该针对具有合理个人自主权水平的个人；（iii）它应该与低水平的正外部性相关联；（iv）它应该与足以产生私人市场的需求相关联；（v）它应该与大多数个人负担得起的支付相关联；最后，（vi）它应该与“生活方式增强”而非“医疗必需品”相关联。该初步框架使人们能够探索与作为一组异质商品的医疗保健相关的个人责任，并使政策制定者能够通过设计而不是默认做出配给决策。
