Drugs – When Is It Reasonable to Pay as an Individual?

Per Carlsson Gustav Tinghög

Almost 20 per cent of the costs for heath- and medical care are currently directly financed by the patients. With an ageing population, the need to prioritize what is to be paid with private and public money, respectively, is reinforced. But the principles for the funding responsibility are currently unclear and often arbitrary In a new report, Professor Per Carlsson and PhD Gustav Tinghög at the National Center for Priority Setting in Health Care present a framework for how, in the future, we can evaluate what services for health and medical care that are reasonable to finance with private funds.

lakemedel_nar_ar_det_rimligt_att_betala_sjalv.pdf 1.0 MB PDF

There are currently large differences between county councils as concerns decisions about the part funded by the individual. The county councils have different levels of fees paid by the individual and the evaluations of what services for medical care and products that the county council should pay. For example, in a few county councils, there is an economic compensation amounting to SEK 2 250 per year to people with gluten intolerance to cover additional costs for special food products, while most county councils pay nothing. The subsidy rules for contraceptive pills for young women also differ between county councils.

In a new report from Centre for Business and Policy Studies (SNS), the authors Per Carlsson and Gustav Tinghög suggest a framework with six criteria for when private funding of medical care can be applied:
SUFFICIENT KNOWLEDGE. It should be possible for the individual to estimate need, quality and efficiency without having to consult medical expertise.
INDEPENDENCE. The users should be able to independently make rational deliberations about the advantages and disadvantages of the treatment.
Small side effects for other people. The effect of the treatment should mainly concern the individual herself and others only to a small degree.
SUFFICIENT DEMAND. Demand should be sufficiently high and regular for a market to emerge, without public subsidies.
REASONABLE PRICE. The yearly cost for the treatment should not exceed a maximum limit determined by society.
IMPROVEMENT OF LIFESTYLE. A treatment that aims at improving performance, functionality or appearance beyond what can be considered as normal functioning should be privately funded.
An application of these principles will probably lead to some patient groups paying more and others less for the treatment that they currently receive.

According to the authors, demographic changes as well as trends in society contribute to make the question about private liability for payment a current topic: At the same rate as the internet has become a natural part of our daily life, patients have in general become more well-informed consumers of medical care and it is not uncommon that they have a clear view of what kind of care that would be best for them as individuals.

-Sweden needs an open debate about when it is reasonable for the patient to cover the costs for his/her care himself/herself. We currently lack clear principles for priorities within medical care. A review is now being carried out in Norway for the third time of their principles for prioritizing health- and medical care. It is time that the Swedish government takes similar initiatives, according to Per Carlsson, Professor at the National Center for Priority Setting in Health Care at Linköping University.

The report is a sub-study in the SNS research programme The Value of New Drugs.

The report was presented at an SNS seminar on October 7.

Participants in the meeting:
KJELL ASPLUND, Professor, Chairman of The Swedish National Council on Medical Ethics, formerly Director General at the National Board of Health and Welfare
PER CARLSSON, Professor, Center for Medical Technology Assessment, Linköping University
LARS ETTARP, Chairman of The Swedish Psoriasis Association and International Federation of Psoriasis Associations IFPA and Member of the Coordination Committee for the Associations for Disabled Persons in the County of Stockholm.
CLAS REHNBERG, Professor of Medical Organization-, Management and Innovation Knowledge, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet
GUSTAV TINGHÖG, PhD, Center for Medical Technology Assessment, Linköping University
BARBRO WESTERHOLM, Professor Emerita, Linköping University, former Director General of the National Swedish Board of Health and Welfare and member of Parliament and spokesperson on questions of medical- and elderly care, The Liberal Party.