The determinants of non-smokers’ opinions about increased health insurance rates for smokers

Background The rates of obligatory health insurance available to Polish citizens do not depend on their health behaviours. However, there are opinions suggesting that the rates should be increased for those who show risky health behaviours. This study aimed at the assessment of determinants of non-smokers' opinions about the introduction of increased health insurance rates for smokers. Methods The analysis was carried out on the data originating from the telephone-based survey on the representative sample of 1000 adult Polish citizens. Responses from non-smokers in the moment of the study were retrieved from the data set. A dichotomised variable derived from the item asking about the opinion about increased insurance rates for smokers was used as a dependent variable in uni- and multivariate logistic regression models. Sociodemographic characteristics, health status, prior use of health care resources, and history of smoking were included as independent variables. Results The study sample included 779 respondents; of them 60.1% (n = 471) never and 0.39.9% (n = 308) smoked in the past. There were 45.0% and 34.4% of supporters of higher rates in these subgroups. Increased insurance rates were supported by older respondents (OR, 95%CI: 1.01,1,001-1.03) and those with higher income (2.17, 1.27-3.70, and 2.23, 1.34-3.71, for the comparisons of two higher income categories with referential category of net income <1500 PLN). Past smokers (0.51, 0.36-0.74), Internet users (0.49, 0.27-0.90), respondents admitted to hospital in preceding year (0.57, 0.36-0.91), and those who reached higher levels of education (0.49, 0.29-0.84, and 0.50, 0.28-0.90 for comparisons between persons with higher levels of education with those with the lowest level) expressed an opposite view. Conclusions Not only earlier experience of tobacco smoking but also higher education level, prior hospital admission and Internet use are related to lack of the acceptance for increased health insurance rates. Key messages Determinants of opinions about increased insurance rates may be counterintuitive. The use of health services or higher education levels are not associated with the support of higher rates for smokers.