Individual responsibility for healthcare financing: application of an analytical framework exploring the suitability of private financing of assistive devices
2012 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, EISSN 1651-1905, Vol. 40, no 8, 784-794 p.Article in journal (Refereed) Published
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. Method: 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.
Place, publisher, year, edition, pages
Sage Publications, 2012. Vol. 40, no 8, 784-794 p.
IdentifiersURN: urn:nbn:se:liu:diva-84316DOI: 10.1177/1403494812462459ISI: 000311854400014OAI: oai:DiVA.org:liu-84316DiVA: diva2:558693