Individual responsibility and health-risk behaviour: a contingent valuation study from the ex ante societal perspective.

This study analyzes peoples' social preferences for individual responsibility to health-risk behaviour in health care using the contingent valuation method adopting a societal perspective. We measure peoples' willingness to pay for inclusion of a treatment in basic health insurance of a hypothetical lifestyle dependent (smoking) and lifestyle independent (chronic) health problem. Our hypothesis is that peoples' willingness to pay for the independent and the dependent health problems are similar. As a methodological challenge, this study also analyzes the extent to which people consider their personal situation when answering contingent valuation questions adopting a societal perspective. 513 Dutch inhabitants responded to the questionnaire. They were asked to state their maximum willingness to pay for inclusion of treatments in basic health insurance package for two health problems. We asked them to assume that one hypothetical health problem was totally independent of behaviour (for simplicity called chronic disease). Alternatively, we asked them to assume that the other hypothetical health problem was totally caused by health-risk behaviour (for simplicity called smoking disease). We applied the payment card method to guide respondents to answer the contingent valuation method questions. Mean willingness to pay was 42.39 Euros (CI=37.24-47.55) for inclusion of treatment for health problem that was unrelated to behaviour, with '5-10' and '10-20 Euros' as most frequently stated answers. In contrast, mean willingness to pay for inclusion treatment for health-risk related problem was 11.29 Euros (CI=8.83-14.55), with '0' and '0-5 Euros' as most frequently provided answers. Difference in mean willingness to pay was substantial (over 30 Euros) and statistically significant (p-value=0.000). Smokers were statistically significantly more (p-value<0.01) willing to pay for the health-risk related (smoking) problem compared with non-smokers, while people with chronic condition were not willing to pay more for the health-risk unrelated (chronic) problem than people without chronic condition. This suggests that sub groups of people might differ in terms of abstracting from their personal situation when answering valuation questions from a societal perspective.