Designing behaviour and healthcare

Listen to the introduction to this forum:

David Cameron has said “I’ll cut the deficit. Not the NHS,” but regardless of what happens at the next election, it seems that the health system will be run on a different basis from the universal system of the past. As Shadow Health Secretary Andrew Lansley says, his proposed Department for Public Health will have “a stronger remit for preventing disease, rather than just its cure. Whenever possible, we will ensure that national public health initiatives funded by public money are focussed wholly on behaviour change and paid for on the basis of the results they achieve.”

The shift towards a provision of healthcare organised around behaviour change will increasingly mean judging access and use of provided services according to whether the individual leads a healthy lifestyle. The motivation for this is not just cutting back public expenditure, even though “unhealthy lives” apparently drain spare resources. Policy makers want to redesign services more closely around peoples’ needs and investigate ways to prevent those same problems occurring in the first place. By focusing on the individual patient, the state can claim that it is acting in our best interest, and even that this approach is more egalitarian as they can understand and connect with vulnerable or disconnected communities in need of support.

Is this behaviour led approach more benevolent than the old universal model, will it result in better healthcare, or is it unacceptably authoritarian?