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Personal Responsibility as a Criterion for Prioritization in Resource Allocation

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Prioritization in Medicine

Abstract

Personal responsibility matters for both rationing and resource allocation. If people were healthier, there would be less competition for absolutely scarce resources such as organs or limited ICU beds. If fewer people were overweight, obese, or smokers, dilemmas arising from relative scarcity could be attenuated, as there would be reduced need for providing (and funding) interventions for conditions such as diabetes, heart disease, stroke, some cancers, or hip or knee-replacements. Yet, how to implement reasonable personal responsibility policies is far from straightforward. In the best case, the stars are aligned and programs empower people’s health literacy and agency, reduce overall healthcare spending, alleviate rationing and resource allocation dilemmas, and lead to healthier and more productive workforces. But the devil is often in the detail: a focus on controlling or reducing cost can also lead to an inequitable distribution of benefits from incentive programs, and penalize people for health risk factors that are beyond their control. This article reviews the different motivations that can underlie and drive personal responsibility policies; sets out a proposal for how to decide on the reasonableness of personal responsibility policies given the constraints of the realpolitik of health policy and the normative issues that are at stake; and provides an overview of central ethical issues raised by incentive programs, the dominant policy tool to promote personal responsibility.

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Notes

  1. 1.

    Gorin et al. (2015).

  2. 2.

    Schroeder (2007).

  3. 3.

    Chatterjee et al. (2014).

  4. 4.

    National Health Service (2013).

  5. 5.

    Schmidt (2008).

  6. 6.

    Ibid.

  7. 7.

    Arneson (1997).

  8. 8.

    Dworkin (2000).

  9. 9.

    Roemer (1995).

  10. 10.

    Roemer (1994).

  11. 11.

    Callahan (1998).

  12. 12.

    Engelhardt (1981).

  13. 13.

    Wikler (1978).

  14. 14.

    Wikler (2004).

  15. 15.

    Buyx (2008).

  16. 16.

    Wilkinson and Marmot (2003).

  17. 17.

    Roemer (1995).

  18. 18.

    Cappelen and Norheim (2005).

  19. 19.

    Le Grand (1991).

  20. 20.

    Feiring (2008).

  21. 21.

    Callahan (2013).

  22. 22.

    Asch et al. (2013).

  23. 23.

    Rawls (1989).

  24. 24.

    Daniels (2007).

  25. 25.

    Daniels and Sabin (1999).

  26. 26.

    Schmidt (2008).

  27. 27.

    Scanlon (1998).

  28. 28.

    American Thoracic Society (1997).

  29. 29.

    Weinrieb et al. (2000).

  30. 30.

    Mathurin et al. (2011).

  31. 31.

    Frederick et al. (2002).

  32. 32.

    Sunstein and Thaler (2008).

  33. 33.

    Loewenstein et al. (2007).

  34. 34.

    Wolff (2015).

  35. 35.

    Schmidt (2009).

  36. 36.

    Volpp et al. (2009).

  37. 37.

    Volpp et al. (2008).

  38. 38.

    Higgins et al. (2010).

  39. 39.

    Jeffery et al. (1978).

  40. 40.

    Oliver and Brown (2012).

  41. 41.

    Baicker et al. (2010), Bödeker et al. (2008).

  42. 42.

    Bödeker et al. (2008).

  43. 43.

    van Baal et al. (2008).

  44. 44.

    Caloyeras et al. (2014).

  45. 45.

    Department of the Treasury, Department of Labor, and Department of Health and Human Services (2006).

  46. 46.

    Madison et al. (2013).

  47. 47.

    Berman et al. (2014).

  48. 48.

    Prainsack and Buyx (2012).

  49. 49.

    Cooper and Trivedi (2012).

  50. 50.

    Asch et al. (2013).

  51. 51.

    Wilkinson and Marmot (2003).

  52. 52.

    Ubel et al. (1999).

  53. 53.

    Volpp and Galvin (2014).

  54. 54.

    Schmidt (2012).

  55. 55.

    Bundesministerium für Gesundheit (2012).

  56. 56.

    Department of the Treasury, Department of Labor, and Department of Health and Human Services (2013).

  57. 57.

    Mattke et al. (2013).

  58. 58.

    Department of the Treasury, Department of Labor, and Department of Health and Human Services (2013).

  59. 59.

    AON Hewitt (2012).

  60. 60.

    Kaiser Family Foundation and Health Research & Educational Trust (2012).

  61. 61.

    National Business Group on Health and Towers Watson (2012).

  62. 62.

    Volpp and Galvin (2014).

  63. 63.

    Schmidt (2012).

  64. 64.

    Department of the Treasury, Department of Labor, and Department of Health and Human Services (2013).

  65. 65.

    Schmidt et al. (2012).

  66. 66.

    Marmot et al. (2013).

  67. 67.

    Schmidt (2013b).

  68. 68.

    McCartney (2013).

  69. 69.

    Kaiser Family Foundation and Health Research & Educational Trust (2012).

  70. 70.

    Wikler (1978).

  71. 71.

    Schmidt (2013a).

  72. 72.

    See, for example, http://www.stickk.com/ for a more individualized approach.

  73. 73.

    Halpern et al. (2015).

  74. 74.

    Frey and Jegen (2001).

  75. 75.

    Sen et al. (2014).

  76. 76.

    Promberger and Marteau (2013).

  77. 77.

    Kullgren et al. (2013).

  78. 78.

    Schmidt (2009).

  79. 79.

    Department of the Treasury, Department of Labor, and Department of Health and Human Services (2013).

  80. 80.

    Madison et al. (2014).

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Authors and Affiliations

  1. Department of Medical Ethics and Health Policy, Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, 3401 Market Street, Suite 320, Philadelphia, PA, 19104-3308, USA

    Harald Schmidt

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  1. Institute for Healthcare Management and Health Sciences, University of Bayreuth, Bayreuth, Bayern, Germany

    Eckhard Nagel

  2. Institute for Healthcare Management and Health Sciences, University of Bayreuth, Bayreuth, Germany

    Michael Lauerer

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Schmidt, H. (2016). Personal Responsibility as a Criterion for Prioritization in Resource Allocation. In: Nagel, E., Lauerer, M. (eds) Prioritization in Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-21112-1_16

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