Willingness to pay for health insurance in Italy: evidence from a survey on consumers' behaviour

This paper examines the willingness to pay (WTP) for duplicative private health insurance in Italy, a country with universal healthcare system characterized by broad public coverage alongside substantial waiting times and relatively high out-of-pocket expenditure. Using nationally representative data from the Italian Survey of Consumer Expectations (ISCE), we elicit individual WTP through a structured bidding mechanism for insurance offering faster access to surgeries, outpatient procedures, and diagnostic examinations already covered by the public system. Willingness to pay increases with income, perceived health risk, prior medical expenditure, and familiarity with insurance products. WTP appears primarily driven by exposure to financial and opportunity costs associated with delayed access rather than by generalized dissatisfaction with public healthcare. We embed a randomized controlled trial providing factual information on public waiting times and private-sector costs. While the intervention does not significantly affect average WTP, it reshapes its determinants: information increases the responsiveness of WTP to direct financial exposure and raises valuations among self-employed individuals and respondents holding inaccurate prior beliefs. Overall, informational frictions influence how individuals weigh economic risks rather than its aggregate level.