B inkmann, Ca olin; Neumann-Böhme, Sebas ian; B ouwe , We ne B. F.;
S a ga d , Tom
A icle — Published Ve sion
Does iming ma e ? The ole o heal h in o ma ion shocks
in measu ing willingness o pay
The Eu opean Jou nal o Heal h Economics
P o ided in Coope a ion wi h:
Sp inge Na u e
Sugges ed Ci a ion: B inkmann, Ca olin; Neumann-Böhme, Sebas ian; B ouwe , We ne B. F.;
S a ga d , Tom (2025) : Does iming ma e ? The ole o heal h in o ma ion shocks in measu ing
willingness o pay, The Eu opean Jou nal o Heal h Economics, ISSN 1618-7601, Sp inge , Be lin,
Heidelbe g, Vol. 26, Iss. 8, pp. 1401-1413,
h ps://doi.o g/10.1007/s10198-025-01774-7
This Ve sion is a ailable a :
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ORIGINAL PAPER
The Eu opean Jou nal o Heal h Economics (2025) 26:1401–1413
h ps://doi.o g/10.1007/s10198-025-01774-7
willingness- o-pay (WTP) can help policymake s assess
alue o money and p io i ize di e en in e en ions based
on indi idual p e e ences as pa o hei alloca i e deci-
sions [1–5].
In heal hca e, his app oach is especially impo an
because he absence o ma ke p ices and he desi e o
policymake s o align hei decisions wi h he p e e ences
o ci izens mean ha alue is usually no obse able. WTP
he e o e has become an es ablished measu e in p e en i e
and cu a i e heal h in e en ions [6, 7]. Ye despi e hei
b oad use and heo e ical unde pinnings, he alidi y o
WTP es ima es has been c i icised, o example due o hei
insensi i i y o scale [8] and hypo he ical bias [9]. Addi ion-
ally, WTP alues a e known o be associa ed wi h he elici-
a ion p ocedu e, aming, and s udy design [10–18].
In oduc ion
To quan i y he alue o non-ma ke ed goods and se ices
such as heal h ca e in e en ions, heal h economic e alu-
a ions o en seek o elici he maximum amoun ha indi-
iduals a e willing o pay o hem. This amoun can hen be
used o es ima e he alue o he in e en ions in mone a y
e ms, acili a ing compa isons be ween hem. In his way,
Ca olin B inkmann
ca olin.b inkmann@uni-hambu g.de
1 Hambu g Cen e o Heal h Economics, Uni e si y o
Hambu g, Hambu g, Ge many
2 E asmus School o Heal h Policy and Managemen , E asmus
Uni e si y Ro e dam, Ro e dam, The Ne he lands
Abs ac
Objec i es The op imal poin in ime o measu e willingness- o-pay (WTP) emains unclea . We in es iga ed he ole o
heal h in o ma ion shocks (HIS) in indi iduals’ WTP, analyzing he ex en o which news o SARS-CoV-2 in ec ions among
people hey know/ hemsel es al e ed WTP o boos e accina ions.
Me hods We elici ed WTP in eigh Eu opean coun ies using he Eu opean Co id Su ey. Fi s , we p esen ed pa icipan s
wi h a hypo he ical se ing ecommending a boos e accina ion ha had o be paid ou -o -pocke . To measu e WTP, we
elici ed a lowe and uppe WTP limi , and a WTP alue con ingen on bo h o hese. To measu e HIS, we asked abou he
du a ion since pa icipan s ecei ed news o COVID-19 cases among people hey know (including hemsel es), as well as
he deg ee o pe sonal connec ion o hese cases and hei se e i y. We used a wo-pa model o es ima e he associa ion
be ween HIS and indi iduals’ WTP.
Resul s Among he 5809 obse a ions, 76.8% s a ed a WTP o a boos e accina ion g ea e han €0. A leas one HIS was
epo ed by 61.9% o pa icipan s. The occu ence o a HIS was associa ed wi h an inc ease in WTP o €14.54 (logis ic:
P <.0001, gamma: P =.1493) compa ed o no HIS. The WTP was highe when he HIS occu ed in he ou weeks be o e he
su ey. Con olling o socio-demog aphic and COVID-19 co a ia es dec eased signi icance and e ec sizes.
Conclusion Ou indings sugges ha a ecen HIS is associa ed wi h a highe p obabili y o ha ing a posi i e WTP. Timing,
in ela ion o some ele an e en , he e o e may ma e when measu ing WTP o heal h in e en ions. I so, inding he
op imal poin in ime o measu e WTP is di icul and may depend on he policy ques ion unde conside a ion.
Keywo ds Willingness o pay · In o ma ion shock · Heal h shock · Vaccina ion
JEL code I10 · I12
Recei ed: 22 Ap il 2024 / Accep ed: 24 Ma ch 2025 / Published online: 17 Ap il 2025
© The Au ho (s) 2025
Does iming ma e ? The ole o heal h in o ma ion shocks in
measu ing willingness o pay
Ca olinB inkmann1· Sebas ianNeumann-Böhme1,2 · We ne B. F.B ouwe 2· TomS a ga d 1
1 3
C. B inkmann e al.
Ano he issue o conside when designing WTP exe cises
in he con ex o heal h in e en ions is when o ask pa ici-
pan s o a alua ion. Jus as he phenomenon ha adap a ion
may a ec subjec i e heal h- ela ed quali y o li e [19–22],
he iming o a WTP exe cise in ela ion o he occu ence
o some ele an ‘shock’ may be associa ed wi h i s esul s.
This may especially be he case i pa icipan s ha e expe i-
enced a heal h e en o heal h in o ma ion shock. The con-
cep o in o ma ion shocks has been he subjec o ecen
heal h esea ch [23–27]. In he p esen s udy, we aimed o
con ibu e o his li e a u e by explo ing he ole o heal h
in o ma ion shocks (HIS) in ela ion o WTP. To do so,
we ocused on he example o SARS-CoV-2 boos e ac-
cina ions, elici ing he hypo he ical WTP o hese in eigh
Eu opean coun ies and in es iga ing he ex en o which
WTP was associa ed wi h he iming o a HIS. We de ined
a HIS ei he as ha ing expe ienced a COVID-19 in ec ion
onesel o ha ing hea d o in ec ions among people one
knows. A he ime o da a collec ion in Decembe 2021
and Janua y 2022, o al cumula i e COVID-19 cases we e
be ween 8,180.7 (Ge many) and 22,777.1 pe 100,000 pe -
sons (Uni ed Kingdom) in Eu ope [28], i.e., a majo i y o
he popula ion had no expe ienced a COVID-19 in ec ion
(ye ). While he Del a a ian was p edominan in inciden
cases in la e Decembe 2021, he mo e con agious omic on
a ian only s a ed o sp ead in Eu ope in ea ly 2022 [29].
Ou esul s sugges ha he occu ence o a HIS is associ-
a ed wi h WTP es ima es, especially in he sho un. A HIS
migh p omp indi iduals o be willing o pay o he o e ed
good. The obse ed associa ion sugges s ha he iming o
WTP su eys migh in luence hei esul s and ul ima ely
a ec alloca ion decisions.
Me hods
The Eu opean Co id Su ey
The Eu opean Co id Su ey (ECOS) was an online su ey
ha elici ed in o ma ion on he a i udes, beha io , wo -
ies, and heal h cha ac e is ics o Eu opean esiden s aged
18 yea s o olde app oxima ely e e y wo mon hs be ween
Ap il 2020 and Decembe 2022. The samples consis ed o
app oxima ely 1000 pa icipan s pe coun y and wa e and
we e ep esen a i e o he gene al popula ion in each coun-
y in e ms o gende and age. The pa icipa ing coun ies
we e Denma k, F ance, Ge many, I aly, Po ugal, he Ne h-
e lands, he Uni ed Kingdom (UK), and, a e July 2021,
Spain. Pa icipan s we e ec ui ed by he ma ke esea ch
company Dyna a. Pa icipa ion was anonymous and
equi ed w i en in o med consen . The ques ionnai es we e
de eloped in English, ansla ed in o he a ious na ional
languages, and pilo ed in 10% o each sample. Fu he
in o ma ion can be ound elsewhe e [30–33]. The p esen
analysis is based on he 9 h wa e o ECOS da a, collec ed
be ween 23 Decembe 2021 and 11 Janua y 2022.
Measu ing heal h in o ma ion shocks (HIS)
We de ined heal h in o ma ion shocks (HIS) as impo an
new in o ma ion ecei ed by pa icipan s abou hei own
heal h o he heal h o someone in hei social en i on-
men . Based on his de ini ion, we measu ed HIS by ask-
ing pa icipan s abou (a) he du a ion since hey hea d news
o COVID-19 cases among people hey know (including
hemsel es), (b) hei deg ee o pe sonal connec ion o hese
cases, and (c) he se e i y o hese cases.
To do so, we used a ma ix in which pa icipan s could
ick boxes o each combina ion o empo al (when? ) and
ela ional (who?) in o ma ion (see Online Resou ce). The
du a ion since ecei ing news abou a case o COVID-19
was shown using wo-week in e als anging om “0 o 2
weeks” o “7 o 8 weeks”, and complemen ed by an open
in e al o “mo e han 8 weeks”. The deg ee o pe sonal
connec ion o hese cases was shown as “household”, “ am-
ily”, “ iends”, “colleagues”, and “no” o “don’ know”.
Sel -shocks (in ec ions among pa icipan s hemsel es)
we e implici ly included in he ca ego y “household”.
Las ly, pa icipan s we e asked o indica e he o e all se e -
i y o he majo i y o he COVID-19 cases, wi h he op ions
anging om “mo e se e e han expec ed” o “milde han
expec ed”, and including a mixed ca ego y (“mixed, i.e.,
hal o he cases mo e se e e han expec ed, and hal o he
cases milde han expec ed”).
When analyzing he da a, we ea ed he ca ego y “Don’
know” he same as he ca ego y “No” based on he assump-
ion ha a case o COVID-19 ha he pa icipan did no
emembe o did no consciously pe cei e would be he
same as ha o he absence o a case o COVID-19.
WTP measu emen
To measu e WTP, we p esen ed pa icipan s wi h a hypo-
he ical scena io in which (a) a boos e accina ion was ec-
ommended, (b) i had o be paid ou o pocke and he cos s
would no be eimbu sed by heal h insu ance o he go e n-
men , (c) pa icipan s’ heal h and accina ion s a us pe mi -
ed a boos e accina ion, (d) pa icipan s could choose hei
p e e ed COVID-19 accine b and, and (e) he accina ion
would be adminis e ed in a con enien loca ion.
Simila o Himmle e al. [34], we op ed o a guided
measu emen p ocedu e o help pa icipan s o m hei WTP
o a non-ma ke ed good. An ini ial il e ques ion iden i ied
whe he indi iduals we e willing o pay a posi i e amoun
1 3
1402
Does iming ma e ? The ole o heal h in o ma ion shocks in measu ing willingness o pay
o a boos e accina ion. Fo hose wi h a posi i e amoun ,
we ollowed a h ee-s ep app oach o elici he WTP o a
boos e sho . Fi s , we asked o he amoun pa icipan s
would ce ainly pay, using a scale anging om €0 o €150
wi h isual ancho ing poin s e e y €30. Al e na i ely, an
open-ended ques ion allowed pa icipan s o indica e a
WTP g ea e han €150. Second, we asked o he amoun
pa icipan s would be unwilling o go beyond, using he
same ins umen s as in he i s s ep. Las ly, pa icipan s
we e asked o s a e hei WTP using an open-ended ques-
ion ph ased in such a way ha i eminded hem o , and
was condi ional on, he p e iously se in e al (see Online
Resou ce).
Fo pa icipan s who s a ed in he ini ial il e ques ion
ha hey had no WTP o a WTP o €0 in he hi d s ep, we
asked o hei mo i a ion in o de o di e en ia e be ween
ue ze os and p o es answe s ha would indica e a iola-
ion o he hypo he ical se ing. Mo i a ion op ions included
(1) no needing he boos e sho because he pa icipan
belie ed he o she would no become ill wi h COVID-19,
(2) no being able o a o d he boos e sho , (3) he boos e
sho being o no alue o he pa icipan because o wo ies
abou po en ial side e ec s, (4) accines gene ally ha ing
no alue o he pa icipan , (5) no wan ing o pay because o
he belie ha accines should be paid by he go e nmen ,
and (6) o he easons. Op ions 1 o 4 we e conside ed o be
e lec i e o a ue WTP o €0. Op ions 5 and 6 we e ega ded
as p o es answe s and hus excluded om he analysis. We
excluded ex eme alues, de ined as WTP alues abo e he
adjus ed g oss disposable income o households pe capi a
o he yea 2020 o each coun y [35].
We asked o alua ions in pa icipan s’ local cu ency.
Fo ou analyses, we con e ed pound s e ling and Dan-
ish k one o eu os using he exchange a e o he Eu opean
Cen al Bank om 23 Decembe 2021. We adjus ed WTP
alues o pu chasing powe pa i y based on he 2020 Eu o-
s a pu chasing powe adjus ed g oss domes ic p oduc pe
capi a [36]. We used condi ional pa hways, dynamic alida-
ion, and piped ex o ensu e he quali y and consis ency
o answe s. Las ly, we iden i ied ca eless esponde s– e.g.,
hose who comple ed he ques ionnai e in less han a hi d
o he median su ey du a ion pe coun y (so-called speed-
e s)– and d opped hese obse a ions [37].
S a is ical analysis
We calcula ed desc ip i e s a is ics o he sample, as well
as WTP and HIS alues. All analyses we e based on he
WTP esponse o he las elici a ion s ep. We es ima ed he
di e ence in WTP depending on he occu ence o HIS
using a wo-pa model because o he con inuous, non-
nega i e na u e o he dependen a iable WTP [38] and
a la ge numbe o ze os. In he i s pa , we modeled he
p obabili y o he WTP being posi i e wi h logis ic eg es-
sion (WTP > 0; WTP = 0). In he second pa , we es ima ed
he WTP, condi ional on i being posi i e, using a gamma
dis ibu ion and log-link unc ion.
We conside ed ou di e en model speci ica ions o
HIS: Model 1 included a bina y a iable indica ing whe he
a pa icipan had been subjec o a HIS. Model 2 included a
ca dinal measu emen o HIS in ensi y (i.e., he numbe o
HIS expe ienced and i s quad a ic e m). Model 3 e e ed
o he mos ecen HIS expe ienced by a pa icipan ; i
included he du a ion since he mos ecen HIS and he
se e i y o he majo i y o COVID-19 cases. Las ly, Model
4 combined he speci ica ions o Models 2 and 3 by adding
he o al numbe o HIS expe ienced in o de o con ol o
expe ience wi h COVID-19. We chose a linea a he han a
squa ed speci ica ion o he numbe o HIS expe ienced by
a pa icipan because he esul s o Model 2 indica ed ha
he ipping poin was app oxima ely six imes he maximum
epo ed numbe o HIS.
Addi ionally, Model 4 con olled o he ollowing
p edic o s o WTP epo ed in he li e a u e: socio-demo-
g aphic cha ac e is ics, pe cei ed h ea om he disease,
pe cei ed bene i s, and p io knowledge o he heal h in e -
en ion [39]. We ope a ionalized socio-economic s a us
using a bina y a iable o gende , six ca ego ies o age,
and a h ee-le el educa ion a iable based on each coun y’s
educa ional quali ica ions (see Online Resou ce), as well as
a ou -ca ego y a iable as a p oxy o income indica ing
he ex en o which pa icipan s we e “able o make ends
mee ”, anging om “easily” o “wi h g ea di icul y”. We
ope a ionalized he pe cei ed h ea om he disease as
quali y o li e measu ed using EQ-5D-5 L and as subjec i e
isk o own heal h om COVID-19 anging om “no isk
a all” o “ e y high isk”. In u n, we ope a ionalized he
pe cei ed bene i o he heal h in e en ion by including (a)
he accina ion s a us o he pa icipan , measu ed using i e
le els anging om no being accina ed/no ye being ac-
cina ed o ha ing ecei ed up o h ee accina ion sho s, and
(b) he accina ion s a us o pee s in ou le els (“none”,
“jus a ew”, “abou hal ”, “mos ”). In addi ion, we included
coun y ixed-e ec s and a isk-a e sion measu e based on
Ba sky e al. [40] wi h ou le els anging om “ e y low”
o “high”. We chose his measu e based on he assump ion
ha i was independen o he COVID-19 pandemic and
would be una ec ed by he HIS examined in ou s udy.
We calcula ed a e age ma ginal e ec s (AME) o acili-
a e in e p e a ion o he esul s o he wo-pa model in
one es ima e. We conduc ed he analysis using he “ wopm”
command [41] in S a a 17.
1 3
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C. B inkmann e al.
ha among pa icipan s wi h a mo e ecen HIS (5–6 weeks:
€44.81, 7–8 weeks: €43.64, > 8 weeks: €47.57, Table 2).
Wi h ega d o he deg ee o pe sonal connec ion o
COVID-19 cases, he di e ences in WTP among pa ici-
pan s we e small. Among hose whose closes COVID-19
case was in he household, he WTP o a boos e accina-
ion was €60.24, ollowed by a WTP o €55.99 i he clos-
es case was in he amily, €50.02 i i was among iends,
and €47.64 i i was among colleagues. Wi h ega d o he
se e i y o HIS, he mean WTP o hose who epo ed ha
he se e i y o he majo i y o cases hey hea d o o expe-
ienced was milde han expec ed was €38.27, wi h hose
epo ing highe se e i y also indica ing a highe mean
WTP (Table 2).
Reg ession esul s
The esul s o Model 1 show ha HIS was associa ed wi h
he WTP o a boos e accina ion (Table 3), wi h he epo
o any HIS being associa ed wi h an inc ease in WTP o
€14.54 compa ed o no HIS. In Model 2, ou indings sug-
ges ha he o al numbe o epo ed HIS and he squa e
o his numbe we e also associa ed wi h WTP, wi h he
squa ed numbe o HIS indica ing ha an inc easing num-
be o HIS was associa ed wi h a dec ease in WTP, bu wi h
a ipping poin a app oxima ely six imes he maximally
epo able numbe o HIS.
In Model 3, which conside ed he du a ion since he
mos ecen HIS, he associa ion o a HIS wi h WTP was
posi i e and s onge i he HIS occu ed in he ou weeks
be o e he su ey (AME o ze o o wo weeks: €20.05;
AME o h ee o ou weeks: €29.20) compa ed o no
HIS (logis ic: P <.003 o all empo al p oximi y le els,
gamma: P =.0492 o epo ing ha ing expe ienced a HIS
h ee o ou weeks be o e he su ey and all o he le els
P >.05). Mo eo e , WTP was posi i ely associa ed wi h he
se e i y o HIS: compa ed o he WTP among hose who
Resul s
Desc ip i e esul s
A e we excluded ca eless esponde s, ex eme alues, p o-
es e s, and missing in o ma ion, he inal sample comp ised
5809 obse a ions (Fig. 1). De ailed sample cha ac e is ics
can be ound in Table 1.
In o al, 23.2% o pa icipan s exp essed a WTP o €0,
whe eas 76.8% exp essed a WTP g ea e han €0. Mo eo e ,
61.9% o pa icipan s epo ed expe iencing a HIS (i.e., a
leas one COVID-19 case), whe eas 38.1% epo ed no
expe iencing any HIS. O hose who epo ed expe ienc-
ing a HIS, 29.4% epo ed one, 22.0% epo ed wo, 12.4%
epo ed h ee, 10.6% epo ed ou , and 14.2% epo ed
i e. The emaining 11.4% epo ed be ween six and he
maximum numbe o 20 HIS. A la ge majo i y o pa ici-
pan s who epo ed expe iencing a HIS indica ed ha hei
mos ecen one had occu ed ze o o wo weeks be o e he
su ey (69.5% o hose who expe ienced a HIS), whe eas
11.5% indica ed ha i had occu ed h ee o ou weeks and
9.9% ha i had occu ed mo e han eigh weeks be o e he
su ey.
On a e age, pa icipan s we e willing o pay €48.58
o a boos e accina ion. The WTP anged om €0.00 o
€7542.60. Pa icipan s who epo ed expe iencing a leas
one HIS indica ed ha ing a highe WTP on a e age han
hose who epo ed no expe iencing a HIS. The di e ence in
he mean WTP be ween hose wi h and hose wi hou a HIS
a ied ac oss coun ies. Wi h ega d o he empo al p oxim-
i y o a HIS, he mean WTP was €55.25 among indi iduals
whose mos ecen HIS occu ed in he wo weeks be o e
he su ey and €60.62 among indi iduals whose mos ecen
HIS occu ed in he h ee o ou weeks be o e he su ey.
Among indi iduals whose mos ecen HIS occu ed mo e
han ou weeks be o e he su ey, he WTP was lowe han
Fig. 1 Flowcha o he sample. HIS– Heal h in o ma ion shock, WTP– Willingness o pay
1 3
1404
Does iming ma e ? The ole o heal h in o ma ion shocks in measu ing willingness o pay
expec ed. O he le els o se e i y we e no associa ed wi h
he WTP (Table 4).
In Model 4, which included con ol a iables, he sig-
ni icance and e ec sizes mos ly dec eased o he du a ion
since he mos ecen HIS and he se e i y o HIS. Compa ed
epo ed he majo i y o cases as being as se e e o as mild
as expec ed, he WTP was lowe among pa icipan s who
epo ed he majo i y o COVID-19 cases as being milde
(AME: €-19.81, logis ic: P <.0001, gamma: P =.0248) han
Table 1 Sample cha ac e is ics
Sample cha ac e is ics pe HIS s a us (N = 5809) Sample cha ac e is ics pe WTP s a emen
(N = 5809)
No HIS (n = 2215) A leas one HIS (n = 3594) WTP = 0 (n = 1349) WTP > 0
(n = 4460)
n%n%n%n%
Gende
Female 1132 51.11 1899 52.84 804 59.60 2227 49.93
Male 1083 48.89 1695 47.16 545 40.40 2233 50.07
Age (yea s)
18–24 107 4.83 325 9.04 118 8.75 314 7.04
25–34 267 12.05 657 18.28 263 19.50 661 14.82
35–44 351 15.85 765 21.29 314 23.28 802 17.98
45–54 417 18.83 644 17.92 299 22.16 762 17.09
55–64 407 18.37 577 16.05 187 13.86 797 17.87
65 o olde 666 30.07 626 17.42 168 12.45 1124 25.20
Educa ion le el
High 867 39.14 1982 55.15 527 39.07 2322 52.06
Middle 944 42.62 1197 33.31 587 43.51 1554 34.84
Low 404 18.24 415 11.55 235 17.42 584 13.09
Abili y o make ends mee
Easily 350 15.80 570 15.86 115 8.52 805 18.05
Fai ly easy 893 40.32 1543 42.93 418 30.99 2018 45.25
Wi h some di icul y 780 35.21 1206 33.56 602 44.63 1384 31.03
Wi h g ea di icul y 192 8.67 275 7.65 214 15.86 253 5.67
Coun y
Denma k 223 10.07 542 15.08 161 11.93 604 13.54
F ance 409 18.47 421 11.71 250 18.53 580 13.00
Ge many 388 17.52 308 8.57 173 12.82 523 11.73
I aly 218 9.84 470 13.08 147 10.90 541 12.13
Ne he lands 254 11.47 414 11.52 213 15.79 455 10.20
Po ugal 217 9.80 486 13.52 84 6.23 619 13.88
Spain 170 7.67 506 14.08 154 11.42 522 11.70
Uni ed Kingdom 336 15.17 447 12.44 167 12.38 616 13.81
Risk a e sion
Ve y low 684 20.66 1459 29.14 308 22.83 1312 29.42
Low 373 11.27 689 13.76 158 11.71 553 12.40
Mode a e 261 7.88 555 11.08 130 9.64 459 10.29
High 1993 60.19 2304 46.02 753 55.82 2136 47.89
Vaccina ion s a us
No 334 15.08 242 6.73 529 39.21 47 1.05
No ye , bu I in end o 35 1.58 61 1.70 55 4.08 41 0.92
Yes, he i s sho 47 2.12 157 4.37 48 3.56 156 3.50
Yes, bo h sho s 654 29.53 1432 39.84 459 34.03 1627 36.48
Yes, h ee sho s (boos e ) 1145 51.69 1702 47.36 258 19.13 2589 58.05
Pee s’ accina ion s a us
Mos 1731 78.15 2811 78.21 764 56.63 3778 84.71
Abou hal 166 7.49 300 8.35 202 14.97 264 5.92
Jus a ew 211 9.53 417 11.60 271 20.09 357 8.00
None 107 4.83 66 1.84 112 8.30 61 1.37
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0.6625) compa ed o hose who epo ed ha he HIS was as
se e e o as mild as expec ed.
Discussion
Main indings
When willingness- o-pay (WTP) exe cises and o he o ms
o con ingen alua ion a e used o elici popula ion p e -
e ences, he iming o elici a ion ela i e o a ele an
e en migh be associa ed wi h he esul s. To in es iga e
his issue, we analyzed whe he ecen heal h in o ma ion
shocks (HIS) we e associa ed wi h WTP.
The esul s o ou eg ession analyses sugges ha HIS a e
indeed posi i ely associa ed wi h WTP o a boos e acci-
na ion o COVID-19, especially du ing he i s ou weeks
a e a HIS. This associa ion may dec ease o e ime bu
o epo ing ha ing no expe ienced any HIS, epo ing ha
he mos ecen HIS had occu ed in he wo weeks o in
he h ee o ou weeks be o e he su ey inc eased he
WTP o a boos e accina ion by €1.92 (logis ic: P =.0025,
gamma: P =.8060) and by €8.95 (logis ic: P =.0095, gamma:
P =.4427), espec i ely. These esul s sugges ha ha ing
expe ienced a HIS was associa ed wi h being willingness
o pay, bu no wi h he heigh o he WTP (condi ional on
being posi i e). I he HIS was epo ed o ha e occu ed
be ween i e and eigh weeks be o e he su ey, com-
pa ed o epo ing no ha ing expe ienced a HIS, he AME
dec eased (€-4.60 and €1.80, espec i ely, all P >.05).
Again, he se e i y o HIS was nega i ely associa ed wi h
being willing o pay i he HIS was epo ed as ha ing been
milde han expec ed (€-6.14, logis ic: 0.0093, gamma:
0.4451) and posi i ely i i was epo ed as ha ing been a
bi mo e se e e (€4.53, logis ic: 0.0589, gamma: 0.6595) o
mo e se e e han expec ed (€5.23, logis ic: 0.0842, gamma:
Table 2 Mean WTP pe coun y and HIS s a us
HIS (n = 3594) No HIS (n = 2215) O e all (N = 5809)
Mean
(in €)
SD
(in €)
Median
(in €)
Mean
(in €)
SD
(in €)
Median
(in €)
T- es
HIS s.
No HIS
Mean
(in €)
SD
(in €)
Median
(in €)
O e all 54.12 144.33 35.56 39.58 144.10 19.81 .0002 48.58 144.4 29.40
Coun y
Denma k (n = 765) 66.30 76.55 51.62 45.91 60.81 33.89 .0001 60.36 72.87 43.01
F ance (n = 830) 41.13 42.50 29.72 37.46 296.83 11.89 .8042 39.32 210.43 19.81
Ge many (n = 696) 70.51 78.41 52.29 51.77 92.39 29.05 .0039 60.06 86.92 40.67
I aly (n = 688) 49.89 60.75 35.56 33.68 58.29 17.78 .0010 44.75 60.41 31.11
Ne he lands (n = 668) 74.92 376.42 37.71 28.50 35.45 18.86 .0131 57.26 297.86 31.43
Po ugal (n = 703) 30.98 43.15 21.71 24.19 27.11 14.48 .0117 28.88 39.02 20.99
Spain (n = 676) 38.16 40.99 28.00 35.63 95.05 12.04 .7366 37.52 59.34 24.00
Uni ed Kingdom (n = 783) 68.72 117.19 47.04 48.06 94.21 29.40 .0064 59.85 108.35 35.28
Time since mos ecen HIS
0–2 weeks 55.25 161.88 36.13
3–4 weeks 60.62 115.27 43.01
5–6 weeks 44.81 60.64 32.53
7–8 weeks 43.64 42.48 31.43
Mo e han 8 weeks 47.57 89.62 30.11
Deg ee o pe sonal connec ion o COVID-19 cases
Household 60.24 74.91 43.56
Family 55.99 210.26 36.16
F iends 50.02 67.63 34.54
Colleagues 47.64 65.86 34.67
Se e i y o majo i y o COVID-19 cases known by
pa icipan
Milde han expec ed 38.27 62.62 24.00
A bi milde han expec ed 50.82 70.51 34.86
As se e e/mild as expec ed 60.12 254.36 38.54
A bi mo e se e e han expec ed 69.30 81.93 54.22
Mo e se e e han expec ed 66.74 61.50 57.90
Mixed, i.e., hal o cases mo e se e e,
hal o cases milde han expec ed
45.74 118.50 24.44
HIS– Heal h in o ma ion shock, SD - S anda d de ia ion
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Does iming ma e ? The ole o heal h in o ma ion shocks in measu ing willingness o pay
could none heless pe sis o e a longe pe iod. Ou esul s
also sugges ha he associa ion be ween HIS and WTP was
especially p onounced h ough inc easing he p obabili y o
ha ing a posi i e WTP (as obse ed in he logis ic eg es-
sion), mo e so han wi h he heigh o he WTP condi ional
on being posi i e.
When an indi idual ecei es news o a po en ial expo-
su e in he ecen pas , i seems plausible ha hey migh
place a highe alua ion on a p e en i e measu e, such as a
boos e accina ion. Howe e , we did no measu e whe he
ou pa icipan s indeed had con ac wi h an in ec ed pe son.
Ano he explana ion could be ha pa icipan s migh e-
e alua e he isk o de eloping COVID-19 hemsel es and
he consequences o con ac ing i . The ac ha he WTP
associa ed wi h a HIS ha occu ed om wo o ou weeks
be o e he su ey was highe han he WTP associa ed wi h
a HIS ha occu ed om ze o o wo weeks be o e he su -
ey migh be ela ed o he ime i akes o se e e symp-
oms and hei consequences o de elop.
Expe iencing a heal h in o ma ion shock, which can be
pe cei ed as a h ea o one’s own heal h, migh ha e a las -
ing consequence on indi iduals’ isk pe cep ions and hus
hei WTP p e e ences. This is suppo ed by empi ical ind-
ings om di e en ields. E idence om he Uni ed S a es
(US), o example, has shown ha egional lood insu -
ance pu chases a e highly co ela ed wi h he le el o lood
damage in he egion du ing he p io yea [42]. Simila ly,
Da e e al. (2020) examined isk pe cep ions o smoking
e-ciga e es be o e and du ing an ou b eak o e-ciga e e o
aping- ela ed lung inju ies in he US in 2019 and 2020.
They epo ed ha isk pe cep ions dec eased when pa ici-
pan s ecei ed mo e in o ma ion ega ding he sou ce o he
ou b eak, bu no o p e-ou b eak le els [24]. O he heal h
shocks, like lu ou b eaks, ha e been hypo hesized o be
associa ed wi h sus ained changes in hygiene p ac ices in
de eloping coun ies [43]. Fu he e idence sugges s simi-
la longe -las ing e ec s [44].
Limi a ions
Ou s udy has a numbe o impo an limi a ions ela ed o
i s se ing, sample, measu emen , and analysis ha mus be
conside ed when in e p e ing i s esul s. Fi s , as we use
c oss-sec ional da a he e, no causal claim can be made based
on ou esul s. Fu he , la en mechanisms d i ing bo h HIS
and he boos e in en ion migh con ibu e o he associa-
ions obse ed in his s udy. Fo ins ance, indi iduals wi h a
highe ea o COVID-19 migh ha e es ed hemsel es and
hei social en i onmen mo e o en o he i us, hus expe-
iencing mo e HIS, han indi iduals wi h a lowe ea o
COVID-19. While he a iable isk o own heal h a emp s
Table 3 Reg ession esul s model 1 and model 2
Model 1 Model 2
Logis ic Gamma AME Logis ic Gamma AME
Es . SE p alue 95%CI Es . SE p alue 95%CI Es . Es . SE p alue 95%CI Es . SE p alue 95%CI Es .
In e cep 0.74 (0.05) < 0.0001 0.65 , 0.83 4.07 (0.07) < 0.0001 3.94 ,4.20 0.80 (0.04) < 0.0001 0.72 , 0.88 4.01 (0.05) < 0.0001 3.90 ,4.12
HIS (Yes) 0.80 (0.06) < 0.0001 0.67 , 0.92 0.12 (0.08) 0.1493 -0.04 , 0.28 14.54
No. O HIS 0.32 (0.03) < 0.0001 0.26 , 0.37 0.08 (0.03) 0.0077 0.02 , 0.14 7.26
No. O HIS² -0.02 (0.00) < 0.0001 -0.02 , -0.01 0.00 (0.00) 0.1779 -0.01 , 0.00 -0.39
AME– A e age ma ginal e ec , Es .– Es ima e, No.– Numbe , SE– S anda d e o
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C. B inkmann e al.
Model 3 Model 4
Logis ic Gamma AME Logis ic Gamma AME
Es . SE p
alue
95%CI Es . SE p
alue
95%CI Es . Es . SE p
alue
95%CI Es . SE p
alue
95%CI Es .
In e cep 0.74 (0.05) <.0001 0.65,
0.83
4.07 (0.06) <.0001 3.94, 4.19 1.57 (0.37) <.0001 0.84, 2.30 4.44 (0.31) <.0001 3.83, 5.05
No. O HIS 0.12 (0.03) 0.0001 0.06, 0.17 0.03 (0.02) 0.0401 0.00, 0.07 2.34
Tempo al p oximi y
0–2 weeks since HIS 1.04 (0.11) <.0001 0.83,
1.25
0.19 (0.11) 0.0953 -0.03, 0.41 20.05 0.50 (0.16) 0.0025 0.17, 0.82 -0.03 (0.10) 0.8060 -0.23, 0.18 1.92
3–4 weeks since HIS 1.03 (0.16) <.0001 0.71,
1.34
0.34 (0.17) 0.0492 0.00, 0.68 29.20 0.55 (0.21) 0.0095 0.14, 0.97 0.10 (0.13) 0.4427 -0.16, 0.36 8.95
5–6 weeks since HIS 0.86 (0.19) <.0001 0.48,
1.24
0.07 (0.22) 0.7437 -0.35, 0.50 12.20 0.39 (0.25) 0.1221 -0.10, 0.88 -0.16 (0.16) 0.3311 -0.47, 0.16 -4.60
7–8 weeks since HIS 0.82 (0.27) 0.0022 0.29,
1.34
0.02 (0.30) 0.9359 -0.56, 0.61 9.60 0.26 (0.33) 0.4365 -0.40, 0.92 0.00 (0.22) 0.9976 -0.42, 0.43 1.80
Mo e han 8 weeks since
HIS
0.80 (0.16) <.0001 0.48,
1.11
0.12 (0.18) 0.5106 -0.24, 0.48 14.09 0.22 (0.20) 0.2882 -0.18, 0.61 0.02 (0.13) 0.8997 -0.25, 0.28 2.30
No HIS . . . . .
Se e i y o HIS
Milde han expec ed -0.70 (0.12) <.0001 -0.93,
-0.46
-0.31 (0.14) 0.0248 -0.57,
-0.04
-19.81 -0.41 (0.16) 0.0093 -0.71, -0.10 -0.08 (0.10) 0.4451 -0.27, 0.12 -6.14
A bi milde han expec ed -0.05 (0.14) 0.7283 -0.32,
0.22
-0.16 (0.14) 0.2297 -0.43, 0.10 -7.99 -0.03 (0.17) 0.8767 -0.35, 0.30 0.01 (0.10) 0.8871 -0.18, 0.21 0.53
As se e e/mild as expec ed . . . . .
A bi mo e se e e han
expec ed
0.21 (0.16) 0.1852 -0.10,
0.53
0.12 (0.15) 0.4333 -0.17, 0.40 8.18 0.36 (0.19) 0.0589 -0.01, 0.73 0.05 (0.11) 0.6595 -0.16, 0.26 4.53
Mo e se e e han expec ed 0.09 (0.18) 0.6228 -0.27,
0.45
0.10 (0.17) 0.5744 -0.24, 0.44 5.98 0.39 (0.23) 0.0842 -0.05, 0.83 0.06 (0.13) 0.6625 -0.20, 0.32 5.23
Mixed, i.e. hal mo e
se e e, hal milde han
expec ed
-0.42 (0.18) 0.0193 -0.78,
-0.07
-0.23 (0.20) 0.2649 -0.62, 0.17 -13.84 -0.40 (0.23) 0.0798 -0.84, 0.05 -0.06 (0.15) 0.6679 -0.35, 0.23 -5.48
No HIS . . . . .
Female 0.20 (0.08) 0.0180 0.03, 0.36 -0.02 (0.06) 0.7070 -0.13, 0.09 0.19
Age
18–24 yea s old -0.43 (0.19) 0.0245 -0.81, -0.06 0.22 (0.14) 0.1067 -0.05, 0.48 9.36
25–34 yea s old -0.65 (0.16) <.0001 -0.96, -0.35 0.02 (0.11) 0.8248 -0.18, 0.23 -2.63
35–44 yea s old -0.64 (0.15) <.0001 -0.93, -0.35 0.02 (0.10) 0.8023 -0.16, 0.21 -2.48
45–54 yea s old -0.78 (0.14) <.0001 -1.05, -0.50 -0.01 (0.09) 0.9420 -0.18, 0.17 -4.87
55–64 yea s old -0.24 (0.15) 0.1185 -0.53, 0.06 -0.04 (0.09) 0.6790 -0.21, 0.13 -2.95
65 yea s old and olde . .
Educa ion le el
High 0.12 (0.13) 0.3525 -0.13, 0.37 0.15 (0.09) 0.0940 -0.03, 0.33 7.67
Table 4 Reg ession esul s model 3 and model 4
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