Willingness to pay for risky lifestyles: results from the Pay for Others (PAY4O) study, Italy

Objectives: We assess the individual willingness to pay for diseases arising from risky lifestyles and
investigate the personal factors that influence such willingness.
Study design: We conducted an online survey with 821 respondents in Italy. The questionnaire was
distributed via Facebook® in July and August 2016. The questionnaire covered sociodemographic characteristics,
health status, behaviour and psychological attitudes, economic status, and opinion about
covering the healthcare costs related to overeating, unhealthy diet, sedentary lifestyles, alcohol abuse,
tobacco smoking, driving under the influence of alcohol, and illegal drug use by.
Methods: We performed the following: (1) the study of the patterns in the dependent variables by
principal component analysis; (2) analysis of the determinants by Holdout Variable Importance measure
obtained in Random Forest; and (3) we used ordered logit models.
Results: Participants agreed with the idea that public health care should be provided for problems arising
from bad eating habits and sedentary lifestyle (50.4%), whereas the health care consequences of the other
risky behaviours should not be publicly financed by the Italian National Health Service.
Conclusions: Our study gives an overview of the willingness to pay of a population living in a country
where financing of the Health Service is based on general taxation. So, these results may be generalized,
with due caution, to all the countries where the Health Service offers universal coverage and is operated
by the government, but of course not to scenarios related to market-based or social health insurance
systems.