Willingness to pay for risky lifestyles: results from the Pay for Others (PAY4O) study, Italy.

OBJECTIVES: We assess the individual willingness to pay for diseases arising from risky lifestyles and investigate the personal factors that influence such willingness. STUDY DESIGN: We conducted an online survey with 821 respondents in Italy. The questionnaire was distributed via Facebook® in July and August 2016. The questionnaire covered sociodemographic characteristics, health status, behaviour and psychological attitudes, economic status, and opinion about covering the healthcare costs related to overeating, unhealthy diet, sedentary lifestyles, alcohol abuse, tobacco smoking, driving under the influence of alcohol, and illegal drug use by. METHODS: We performed the following: (1) the study of the patterns in the dependent variables by principal component analysis; (2) analysis of the determinants by Holdout Variable Importance measure obtained in Random Forest; and (3) we used ordered logit models. RESULTS: Participants agreed with the idea that public health care should be provided for problems arising from bad eating habits and sedentary lifestyle (50.4%), whereas the health care consequences of the other risky behaviours should not be publicly financed by the Italian National Health Service. CONCLUSIONS: Our study gives an overview of the willingness to pay of a population living in a country where financing of the Health Service is based on general taxation. So, these results may be generalized, with due caution, to all the countries where the Health Service offers universal coverage and is operated by the government, but of course not to scenarios related to market-based or social health insurance systems.

Benchmarking of energy consumption in municipal wastewater treatment plants - a survey of over 200 plants in Italy.

One of the largest surveys in Europe about energy consumption in Italian wastewater treatment plants (WWTPs) is presented, based on 241 WWTPs and a total population equivalent (PE) of more than 9,000,000 PE. The study contributes towards standardised resilient data and benchmarking and to identify potentials for energy savings. In the energy benchmark, three indicators were used: specific energy consumption expressed per population equivalents (kWh PE-1 year-1), per cubic meter (kWh/m3), and per unit of chemical oxygen demand (COD) removed (kWh/kgCOD). The indicator kWh/m3, even though widely applied, resulted in a biased benchmark, because highly influenced by stormwater and infiltrations. Plants with combined networks (often used in Europe) showed an apparent better energy performance. Conversely, the indicator kWh PE-1 year-1 resulted in a more meaningful definition of a benchmark. High energy efficiency was associated with: (i) large capacity of the plant, (ii) higher COD concentration in wastewater, (iii) separate sewer systems, (iv) capacity utilisation over 80%, and (v) high organic loads, but without overloading. The 25th percentile was proposed as a benchmark for four size classes: 23 kWh PE-1 y-1 for large plants > 100,000 PE; 42 kWh PE-1 y-1 for capacity 10,000 < PE < 100,000, 48 kWh PE-1 y-1 for capacity 2,000 < PE < 10,000 and 76 kWh PE-1 y-1 for small plants < 2,000 PE.