Willingness to pay for health protection: Inadequate sensitivity to probability?

Efficient investments in health protection require valid estimates of the public's willingness to forgo consumption for diminished probabilities of death, injury, and disease. Stated valuations of risk reduction are not valid measures of economic preference if the valuations are insensitive to probability variation. This article reviews the existing literature on CV studies of reductions in health risk and finds that most studies are poorly designed to assess the sensitivity of stated valuations to changes in risk magnitude. Replication of a recent study published in this journal by Johannesson et al. (1997) demonstrates how serious the problem of insensitivity can be, even for a study that reports plausible results. New empirical results are presented from telephone surveys designed to provide internal and external tests of how WTP responds to size of risk reduction. The effect of variations in instrument design on estimated sensitivity to magnitude is examined. Overall, estimated WTP for risk reduction is inadequately sensitive to the difference in probability, that is, the magnitude of the difference in WTP for different reductions in risk is typically smaller than suggested by standard economic theory. Additional research to improve methods for communicating changes in risk is needed, and future studies of stated WTP to reduce risk should include rigorous validity checks.