Risky Behaviours and Responsibility-Sensitive Fairness in a Non Life-Threatening Health Case: A European Study

Risky behaviours are found to substantially increase medical and social costs and mortality. In this paper, we document the extent to which a sample of European students (from Denmark, France, Italy and Sweden) consider that individuals should assume the financial burden of paying the costs of risky behaviour. Using an empirical social choice methodology, we test in a positive manner the acceptability of different ways of financing costs due to ill-health more or less associated with risky behaviour in accordance with a normative framework relating to responsibility-sensitive fairness. We particularly check the sensitivity of our sample to responsibility in a health context with questions that make it possible to clearly distinguish between risky behaviour under an individual’s control and circumstances beyond the individual’s control. The health conditions chosen in this study are not life-threatening, but the specific disease varies in different parts of the survey. We find that the majority of students approve of responsibility-sensitive fairness but that the specific health context, the type of risky behaviours involved, and the framing all matter as determinants of the choices made by the individuals of our sample in the financing of health care. We also find that students’ nationality has a small influence.