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Priority setting and personal health responsibility: an analysis of Norwegian key policy documents
  1. Gloria Traina,
  2. Eli Feiring
  1. Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
  1. Correspondence to Gloria Traina, Department of Health Management and Health Economics, University of Oslo, Oslo 0317, Norway; gloria.traina{at}medisin.uio.no

Abstract

Background The idea that individuals are responsible for their health has been the focus of debate in the theoretical literature and in its concrete application to healthcare policy in many countries. Controversies persist regarding the form, substance and fairness of allocating health responsibility to the individual, particularly in universal, need-based healthcare systems.

Objective To examine how personal health responsibility has been framed and rationalised in Norwegian key policy documents on priority setting.

Methods Documents issued or published by the Ministry of Health and Care Services between 1987 and 2018 were thematically analysed (n=14). We developed a predefined conceptual framework that guided the analysis. The framework included: (1) the subject and object of responsibility, (2) the level of conceptual abstraction, (3) temporality, (4) normative justificatory arguments and (5) objections to the application of personal health responsibility.

Results As an additional criterion, personal health responsibility has been interpreted as relevant if: (A) the patient’s harmful behaviour is repeated after receiving treatment (retrospectively), and if (B) the success of the treatment is conditional on the patient’s behavioural change (prospectively). When discussed as a retrospective criterion, considerations of reciprocal fairness have been dominant. When discussed as a prospective criterion, the expected benefit of treatment justified its relevance.

Conclusion Personal health responsibility appears to challenge core values of equality, inclusion and solidarity in the Norwegian context and has been repeatedly rejected as a necessary criterion for priority setting. However, the responsibility criterion seems to have some relevance in particular priority setting decisions.

  • Norway
  • document analysis
  • personal health responsibility
  • priority setting
  • self-inflicted diseases
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Footnotes

  • Contributors GT provided the conception and design of the study, selected the material, interpreted the findings and was responsible for drafting the manuscript and making substantial revisions in all phases. EF assisted the design of the study, assisted in the selection, analysis and interpretation of the material and revised the drafts substantially for important intellectual content. Both authors gave final approval of the version to be submitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon request

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