The role of taxation in tobacco control and its potential economic impact in China

ObjectivesTo identify key economic issues involved in raising the tobacco tax and to recommend possible options for tobacco tax reform in China.MethodsEstimated price elasticities of the demand for cigarettes, prevalence data and epidemiology are used to estimate the impact of a tobacco tax increase on cigarette consumption, government tax revenue, lives saved, employment and revenue loss in the cigarette industry and tobacco farming.ResultsThe recent Chinese tax adjustment, if passed along to the retail price, would reduce the number of smokers by 630,000 saving 210,000 lives, at a price elasticity of -0.15. A tax increase of 1 RMB (or US$0.13) per pack of cigarettes would increase the Chinese government's tax revenue by 129 billion RMB (US 17.2 billion), decrease consumption by 3.0 billion packs of cigarettes, reduce the number of smokers by 3.42 million and save 1.14 million lives.ConclusionThe empirical economic analysis and tax simulation results clearly indicate that increasing the tobacco tax in China is the most cost-effective instrument for tobacco control

Economic Burden for Lung Cancer Survivors in Urban China.

BackgroundWith the rapid increase in the incidence and mortality of lung cancer, a growing number of lung cancer patients and their families are faced with a tremendous economic burden because of the high cost of treatment in China. This study was conducted to estimate the economic burden and patient responsibility of lung cancer patients and the impact of this burden on family income.MethodsThis study uses data from a retrospective questionnaire survey conducted in 10 communities in urban China and includes 195 surviving lung cancer patients diagnosed over the previous five years. The calculation of direct economic burden included both direct medical and direct nonmedical costs. Indirect costs were calculated using the human capital approach, which measures the productivity lost for both patients and family caregivers. The price index was applied for the cost calculation.ResultsThe average economic burden from lung cancer was $43,336 per patient, of which the direct cost per capita was$42,540 (98.16%) and the indirect cost per capita was $795 (1.84$30,277 per capita, which accounted for 171% of the household annual income, a percentage that fell to 107% after subtracting the compensation from medical insurance.ConclusionsThe economic burden for lung cancer patients is substantial in the urban areas of China, and an effective control strategy to lower the cost is urgently needed

ECONOMIC ANALYSIS OF TOBACCO AND OPTIONS FOR TOBACCO CONTROL: China Case Study

More than 320 million people in China smoke, which accounts for nearly one-third of all the smokers in the world. Almost two-thirds of adult Chinese men are smokers. On the other hand, tobacco production is a state-run enterprise that provides substantial earnings and tax revenue for the government. This paper addresses this policy dilemma by analyzing the impact of an additional cigarette tax on the entire economy. Economic analyses have shown that price elasticities of the demand for cigarettes range from –0.40 to –0.70. At a price elasticity of –0.54, for instance, a 40 cent increase in tax from 1.60 yuan per pack to 2.00 yuan tax per pack (raising the retail price from 4.00 yuan to 4.40 yuan) would reduce consumption by 4.57 billion packs, generate additional central government revenues of 24.74 billion Yuan and save 1.44 to 2.16 million lives. The increase in central government tax revenue would be twice as large as the total losses in industry revenue, tobacco farmers’ incomes and local tax revenue (12.27 billion Yuan). Therefore, considering both the health and economic benefits, additional taxation on cigarettes in China would be a desirable public policy for the Chinese government to consider

The role of taxation in tobacco control and its potential economic impact in China.

ObjectivesTo identify key economic issues involved in raising the tobacco tax and to recommend possible options for tobacco tax reform in China.MethodsEstimated price elasticities of the demand for cigarettes, prevalence data and epidemiology are used to estimate the impact of a tobacco tax increase on cigarette consumption, government tax revenue, lives saved, employment and revenue loss in the cigarette industry and tobacco farming.ResultsThe recent Chinese tax adjustment, if passed along to the retail price, would reduce the number of smokers by 630,000 saving 210,000 lives, at a price elasticity of -0.15. A tax increase of 1 RMB (or US$0.13) per pack of cigarettes would increase the Chinese government's tax revenue by 129 billion RMB (US 17.2 billion), decrease consumption by 3.0 billion packs of cigarettes, reduce the number of smokers by 3.42 million and save 1.14 million lives.ConclusionThe empirical economic analysis and tax simulation results clearly indicate that increasing the tobacco tax in China is the most cost-effective instrument for tobacco control

Smoking Knowledge, Attitudes, Behavior, and Associated Factors Among Chinese Male Surgeons

The purpose of this study was to understand and assess the smoking knowledge, attitudes, behavior, and associated factors among Chinese male surgeons. A total of 823 Chinese male surgeons from six cities in China participated in a survey of smoking knowledge, attitudes, and behaviors in 2004. This study presents descriptive statistics and logistic regression analyses of factors associated with the respondents’ smoking behavior and smoking cessation activity. The current smoking prevalence for Chinese male surgeons was 45.2, and 42.5% of respondents reported having smoked in front of their patients. Few of the respondents always asked patients about their smoking status (25%) or advised smokers to quit smoking (27.2%). Logistic regression models found that current smoking status was significantly associated (P < 0.05) with the surgeons’ knowledge of the harms of active and passive smoking and their attitudes toward smoke-free hospitals and health role modeling by physicians. Smoking in front of patients was significantly associated (P < 0.05) with the respondents’ knowledge of active smoking harms, attitudes toward smoke-free hospitals, and cigarette consumption. The surgeons’ smoking cessation activity was significantly associated (P < 0.05) with their knowledge about the harms of active smoking, their rates of advising patients to quit smoking, and their knowledge of the harms of passive smoking. Male surgeons have the highest smoking prevalence among Chinese physicians. They should actively participate in tobacco control training and education to improve their knowledge and attitudes toward smoking, which will improve their own smoking behavior and smoking cessation practices. Only by engaging all parts of the health care system, including surgeons, can China make headway against its tobacco epidemic

Catastrophic health expenditure: A comparative analysis of smoking and non-smoking households in China.

INTRODUCTION:Smoking is hazardous to health and places a heavy economic burden on individuals and their families. Clearly, smoking in China is prevalent since China is the largest consumer of tobacco in the world. Chinese smoking and nonsmoking households were compared in terms of the incidence and intensity of Catastrophic Health Expenditures (CHEs). The factors associated with catastrophic health expenditures were analyzed. METHODS:Data for this study were collected from two waves of panel data in 2011 and 2013 from the national China Health and Retirement Longitudinal Study (CHARLS). A total of 8073 households with at least one member aged above 45 were identified each year. Catastrophic health expenditure was measured by the ratio of a household's out-of-pocket healthcare payments (OOP) to the household's Capacity to Pay (CTP). A panel logit random-effects model was used to examine correlates with catastrophic health expenditure. RESULTS:The incidence of catastrophic health expenditures for Chinese households with members aged 45 and above in 2011 and 2013 were 12.99% and 15.56%, respectively. The mean gaps (MGs) were 3.16% and 4.88%, respectively, and the mean positive gaps (MPGs) were 24.36% and 31.40%, respectively. The incidences of catastrophic health expenditures were 17.41% and 20.03% in former smoking households, 12.10% and 15.09% in current smoking households, and 12.72% and 13.64% in nonsmoking households. In the panel logit regression model analysis, former smoking households (OR = 1.444, P<0.001) were more prone to catastrophic health expenditures than nonsmoking households. Risk factors for catastrophic health expenditures included members with chronic diseases (OR = 4.359, P<0.001), hospitalized patients (OR = 8.60, P<0.001), elderly people aged above 65 (OR = 1.577, P<0.001), or persons with disabilities (OR = 1.275, P<0.001). Protective factors for catastrophic health expenditures included being in an urban household, having a larger family size, and having a higher household income. CONCLUSIONS:The incidence of catastrophic health expenditures in Chinese households is relatively high. Smoking is one of the primary risk factors for catastrophic health expenditures. Stronger interventions against smoking should be made in time to reduce the occurrence of health issues caused by smoking and the financial losses for individuals, families and society

A Clustered Randomized Controlled Trial to Reduce Secondhand Smoke Exposure Among Nonsmoking Pregnant Women in Sichuan Province, China.

IntroductionNonsmoking pregnant women in China have significant exposure to secondhand smoke (SHS). Few interventions have focused on pregnant women reducing their SHS exposure.MethodsThis clustered randomized controlled trial, conducted at eight hospitals in Sichuan, China, compared a prenatal health education intervention with usual clinical care as a control. The primary outcome was self-reported "no SHS exposure" before and 3 months after birth. The intervention consisted of three large group educational sessions, standardized clinician advice, brief monthly follow-up calls, and educational materials and resources. A random sample of participants was biochemically validated before birth with hair nicotine, a long-term biomarker of smoke exposure.ResultsOverall, 1181 participants were randomized to intervention (n = 526) and control (n = 655) groups. More participants in the intervention group than the control group reported no SHS exposure 3 months after birth (Total: 77.9% vs. 52.6%, P &lt; .001; Home: 81.2% vs. 53.3%, P &lt; .001). The intervention group also had greater changes in improved smoke-free homes and SHS knowledge and attitudes. Controlling for covariates, the intervention group was less likely to report SHS exposure than the control group (Total: OR = 0.47, 95% CI = 0.31 to 0.71; Home: OR = 0.33, 95% CI = 0.21 to 0.53), and this effect was sustained 3 months after birth. The adjusted log concentration of hair nicotine for the intervention group decreased by 0.28 log µg/g more than the control group.ConclusionsOur smoke-free health education intervention for nonsmoking pregnant women significantly reduced SHS exposure before and after birth. This intervention model can become part of a standard protocol for the care of pregnant women in hospital settings

The healthcare costs of secondhand smoke exposure in rural China

ObjectiveThe goal of this study was to assess the healthcare costs attributable to secondhand smoke (SHS) exposure among non-smoking adults (age ≥ 19) in rural China.MethodsWe analysed data from the 2011 National Rural Household Survey which was conducted among adults in five provinces and one municipality in China (N=12,397). Respondents reported their smoking status, health conditions and healthcare expenditures. Relative risks were obtained from published sources. Healthcare costs included annual outpatient and inpatient hospitalisation expenditures for five SHS-related diseases: asthma, breast cancer (female only), heart disease, lung cancer and tuberculosis. SHS-attributable healthcare costs were estimated using a prevalence-based annual cost approach.FindingsThe total healthcare costs of SHS exposure in rural China amounted to $1.2 billion in 2011, including$559 million for outpatient visits and $612.4 million for inpatient hospitalisations. The healthcare costs for women and men were$877.1 million and $294.3 million, respectively. Heart disease was the most costly condition for both women ($701.7 million) and men ($180.6 million). The total healthcare costs of SHS exposure in rural China accounted to 0.3% of China's national healthcare expenditures in 2011. Over one-fifth of the total healthcare costs of SHS exposure in rural China were paid by health insurance. The out-of-pocket expenditures per person accounted for almost half (47%) of their daily income.ConclusionsThe adverse health effects of SHS exposure result in a large economic burden in China. Tobacco control policies that reduce SHS exposure could have an impact on reducing healthcare costs in China