Get access

Responsibility-Sensitive Fairness in Health Financing: Judgments in Four European Countries


  • This article was published online on 27 February 2014 . Errors were subsequently identified. Conflict of Interest statement and Acknowledgements were added. This notice is included in the online and print versions to indicate that both have been corrected 01 April 2014.


Risky health behaviours substantially increase medical and social costs. 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. We test the acceptability of different ways of financing costs because of ill health that is more or less associated with risky behaviour in accordance with a normative framework relating to responsibility-sensitive fairness. We find that the majority of students agree with assuming financial responsibility for risky behaviours and that there should be compensation for unfavourable circumstances. Students agree that two individuals with the same responsibility variables should make an equal financial contribution and that more effort in maintaining health for given circumstances should be rewarded with a lower financial contribution. The specific health context and the type of risky behaviours involved matter in determining perceptions of justice in health financing. Copyright © 2014 John Wiley & Sons, Ltd.