Responsibility Considerations and the Design of Health Care Policies: A Survey Study of the Norwegian Population
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Responsibility Considerations and the Design of Health Care Policies: A Survey Study of the Norwegian Population Cornelius Cappelen1 · Tor Midtbø1 · Kristine Bærøe2 Accepted: 7 November 2020 © Springer Nature B.V. 2020
Abstract The objective of this article is to explore people’s attitudes toward responsibility in the allocation of public health care resources. Special attention is paid to conceptualizations of responsibility involving blame and sanctions. A representative sample of the Norwegian population was asked about various responsibility mechanisms that have been proposed in the theoretical literature on health care and personal responsibility, from denial of treatment to a tax on unhealthy consumer goods. Survey experiments were employed to study treatment effects, such as whether fairness considerations affect attitudes about responsibility. We find that, overall, a substantial minority of the respondents find it fair to let the health care system sanction people—in one way or another—for voluntary behaviors that increase the risk of becoming ill. Quite surprisingly, we find that people are more prone to report that they should themselves be held responsible for unhealthy lifestyles than others. Keywords Health · Personal responsibility · Fairness
Introduction More than 70% of diseases sworldwide are non-communicable (Steel 2017). Smoking, drinking, lack of exercise, and unhealthy eating habits all contribute to the risk of becoming ill and dying prematurely. A highly relevant question arises for any health care system with resource constraints and a call for setting limits to what is * Cornelius Cappelen [email protected] Tor Midtbø [email protected] Kristine Bærøe [email protected] 1
Department of Comparative Politics, University of Bergen, Bergen, Norway
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Department of Comparative Politics, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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offered: Is it fair to hold people responsible—in one way or another—for lifestyle choices with potentially adverse health impacts? Even though some of the highest risk factors for poor health in Norway today are unhealthy nutrition, smoking, and obesity (Norges Offentuge Utreninger 2014), such a discussion was not part of the mandate of the third Norwegian commission on priority settings in health appointed in 2014. The role of personal responsibility in health was thoroughly discussed, and the fairness of involving that kind of consideration in the distribution of health care was dismissed by Norway’s first commission on priority setting in 1987 (Norges Offentuge Utreninger 1987). This might explain why it was rejected as a relevant concern almost 30 years later. At the same time, the relevance of personal responsibility in health has been highly debated in the international academic literature; it has also been part of health care policy-making in other countries (Schmidt 2009), and a study by Bringedal and Feiring (2011) suggests that Norwegian physicians do in f
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