Individual rights and duties in health policy

A growing body of thought in the literature and the policy debate is calling for eligibility criteria and funding methods in health care to be predicated on individual responsibility. To date this approach has had no tangible impact on public health systems: the choice adopted is to avoid discrimination in access to health services, while instead emphasising public intervention intended to influence behaviour. As regards forms of intervention, we observe the expansion of the standard instruments: mandatory rules, information, education, subsidies and taxes. However, a new approach is also emerging. This is labelled «libertarian paternalism» to indicate that it pursues an acceptable compromise between the corrective objective and respect for the freedom of individual choice. We argue that this road should be pursued cautiously, with prior assessment and ex-post evaluation of the impact of interventions designed to affect individual behaviour, through an appropriate adaptation of the traditional criteria of cost-effectiveness analysis.