Sanctioning risky life-styles: Attitudes toward solidarity or equitable distribution of health care

Rising costs of medical care and increasing knowledge about behavior-related health risks favor the use of the equity principle in health care allocation. This paper deals with attitudes to the question of whether or not one's payments should be contingent upon the risks one takes. From an explorative analysis of arguments espoused by letter writers from a Dutch health magazine, it becomes apparent that equity plays a major role in the respondents' views of the distribution of health care facilities. Next, the role of attribution in adopting attitudes toward risky life-styles is studied on the basis of a survey using a representative sample of Dutch households. Beliefs about the individual ability to influence health have no effect on risk solidarity, whereas beliefs about the proper amount of effort to avoid health risks do have an effect.