Tobacco tax as a health protecting policy: a brief review of the New Zealand evidence

AIM

To review the evidence relating to tobacco taxation as a health and equity protecting policy for New Zealand.

METHODS

Searches of Medline, EconLit, ECONbase, Index NZ, and library databases for literature on tobacco taxation.

RESULTS

The New Zealand evidence indicates that increases in tobacco prices are associated with decreases in tobacco consumption in the general population over the long term. This finding comes from multiple studies relating to: tobacco supplies released from bond, supermarket tobacco sales, household tobacco expenditure data, trends in smoking prevalence data, and from data on calls to the Quitline service. For the 1988-1998 period, the overall price elasticity of demand for all smoking households was estimated to be such that a 10% price increase would lower demand by 5% to 8%. Two studies are suggestive that increased tobacco affordability is also a risk factor for higher youth smoking rates. There is evidence from two studies that tobacco price increases reduce tobacco consumption in some low-income groups and one other study indicates that tobacco taxation is likely to be providing overall health benefit to low-income New Zealanders. These findings are broadly consistent with the very large body of scientific evidence from other developed countries.

CONCLUSIONS

There is good evidence that tobacco taxation is associated with reduced tobacco consumption in the New Zealand setting, and some limited evidence for equity benefits from taxation increases. Substantial scope exists for improving tobacco taxation policy in New Zealand to better protect public health and to improve equity.

The effect of health savings accounts on health insurance coverage

The authors investigate the potential of Health Savings Accounts (HSAs) to expand health insurance coverage. They examine how many currently uninsured people might be encouraged to buy coverage through HSAs, and what the impacts of such actions might be on the group and nongroup health insurance markets. Their main conclusions: HSAs are not likely to be an important contributor to expanding coverage among uninsured people because most of them do not face high-enough marginal tax rates to benefit substantially from the tax deductibility of HSA contributions. Meanwhile, HSAs could potentially destabilize the small-group market. To the extent that they encourage well-compensated healthy workers to abandon job-based coverage--a result that is more likely if current HSA provisions are combined with proposed premium deductibility--HSAs could undermine the entire structure of job-based coverage among small firms.

Radiology applications of financial accounting

A basic knowledge of financial accounting can help radiologists analyze business opportunities and examine the potential impacts of new technology or predict the adverse consequences of new competitors entering their service area. The income statement, balance sheet, and cash flow statement are the three basic financial statements that document the current financial position of the radiology practice and allow managers to monitor the ongoing financial operations of the enterprise. Pro forma, or hypothetical, financial statements can be generated to predict the financial impact of specific business decisions or investments on the profitability of the practice. Sensitivity analysis, or what-if scenarios, can be performed to determine the potential impact of changing key revenue, investment, operating cost or financial assumptions. By viewing radiology as both a profession and a business, radiologists can optimize their use of scarce economic resources and maximize the return on their financial investments.

Cigarette tax avoidance and evasion

Variation in state cigarette taxes provides incentives for tax avoidance through smuggling, legal border crossing to low tax jurisdictions, or Internet purchasing. When taxes rise, tax paid sales of cigarettes will decline both because consumption will decrease and because tax avoidance will increase. The key innovation of this paper is to compare cigarette sales data to cigarette consumption data from the Behavioral Risk Factor Surveillance System (BRFSS). I show that after subtracting percent changes in consumption, residual percent changes in sales are associated with state cigarette tax changes implying the existence of tax avoidance. I estimate that the tax avoidance response to tax changes is at least twice the consumption response and that tax avoidance accounted for up to 9.6% of sales between 1985 and 2001. Because of the increase in tax avoidance, tax paid sales data understate the level of smoking and overstate the drop in smoking. I also find that the level of legal border crossing was very low relative to other forms of tax avoidance. If states have strong preferences for smoking control, they must pair high cigarette taxes with effective policies to curb smuggling and other forms of tax avoidance or employ alternative policies such as counter-advertising and smoking restrictions.

Tobacco control: recent movements in Japan

Tobacco control in Japan has not kept pace with the rest of the global community in the past several decades. Although recent movements in Japan suggest that some changes will occur, most of the initiatives are still circumspect at best. The motivations driving most of these changes come from concern for morals about obeying the law and propriety of consideration for nonsmokers in public places, rather than for health. Moreover, the complicated relationship between the government and the tobacco industry, as well as between the two ministries that oversee the industry, may act as obstacles to any real comprehensive tobacco control.

Complicity in contraband: British American Tobacco and cigarette smuggling in Asia

OBJECTIVES

To examine the complicity of British American Tobacco (BAT) in cigarette smuggling in Asia, and to assess the centrality of illicit trade to regional corporate strategy.

METHODS

Analysis of previously confidential documents from BAT's Guildford depository. An iterative strategy combined searches based on geography, organisational structure, and key personnel, while corporate euphemisms for contraband were identified by triangulation.

RESULTS

BAT documents demonstrate the strategic importance of smuggling across global, regional, national, and local levels. Particularly important in Asia, contraband enabled access to closed markets, created pressure for market opening, and was highly profitable. Documents demonstrate BAT's detailed oversight of illicit trade, seeking to reconcile the conflicting demands of control and deniability.

CONCLUSIONS

BAT documents demonstrate that smuggling has been driven by corporate objectives, indicate national measures by which the problem can be addressed, and highlight the importance of a coordinated global response via WHO's Framework Convention on Tobacco Control.

"A phony way to show sincerity, as we all well know": tobacco industry lobbying against tobacco control in Hong Kong

OBJECTIVE

To examine the tobacco industry's efforts to influence public policy and block the legislative process on tobacco control in Hong Kong, 1973 to 1997.

METHOD

Systematic review of relevant tobacco industry documents made public via the Master Settlement Agreement.

RESULTS

The tobacco industry in Hong Kong has sought to manipulate the policymaking process and delay the introduction of tobacco control legislation in Hong Kong from at least 1973. The industry ensured that each of the government's initial meagre steps toward tobacco control were delayed and thwarted by drawn out "cooperation" followed by voluntary concessions on issues the industry regarded as minor. By the 1980s the government had became increasingly active in tobacco control and introduced a number of initiatives, resulting in some of the tightest legislative restrictions on smoking in Asia. The tobacco industry was successful in thwarting only one of these initiatives.

CONCLUSIONS

Throughout the 1980s and 1990s two factors played a significant role in hindering the tobacco industry from successfully blocking policy initiatives: a growing political imperative, and an active and sophisticated tobacco control movement. Political will to promote public health and a strong tobacco control advocacy presence can enable governments to resist the enormous pressure exerted upon them by multinational tobacco companies.

Driving forces for import of waste for energy recovery in Sweden

Between 1996 and 2002, the Swedish import of so-called yellow waste for energy recovery increased. The import mainly consisted of separated wood waste and mixes of used wood and paper and/or plastics that was combusted in district heat production plants (DHPPs). Some mixed waste was imported to waste incineration plants for energy recovery (10% of the import of yellow waste for energy recovery in 2002). The import came primarily from Germany, the Netherlands, Norway, Denmark and Finland. We identified six underlying driving forces for this recent increase of imported waste which are outlined and their interactive issues discussed. --The energy system infrastructure, which enables high energy recovery in Sweden. --The energy taxation, where high Swedish taxes on fossil fuels make relatively expensive solid biofuels the main alternative for base load production of district heat. --The quality of the waste-derived fuels, which has been higher in the exporting countries than in Sweden. --The bans on landfilling within Europe and the shortage of waste treatment capacity. --Taxes on waste management in Europe. --Gate fee differences between exporting countries and Sweden. In the future, the overall strength of these driving forces will probably be weakened. A Swedish tax on waste incineration is being investigated. In other European countries, the ambition to reach the Kyoto targets and increase the renewable electricity production could improve the competitiveness of waste-derived fuels in comparison with fossil fuels. Swedish DHPPs using waste-derived fuels will experience higher costs after the Waste Incineration Directive is fully implemented. The uncertainty about European waste generation and treatment capacity, however, might have a large influence on the future gate fees and thus also on the yellow waste import into Sweden.

Strength of clean indoor air laws and smoking related outcomes in the USA

OBJECTIVES

Environmental tobacco smoke (ETS) is often encountered in the workplace. There have been efforts to apply and enforce state laws limiting workplace smoking. There has been little study of the relative effectiveness of state and/or local laws in affecting both rates of workplace ETS exposure and adult smoking rates. This study investigates these hypotheses, as well as the effect of these laws on youth smoking.

DESIGN

This is a secondary data analysis using sources including the Current Population Survey (CPS), Behavioral Risk Factor Surveillance System (BRFSS), Youth Risk Behavior Survey (YRBS), and the National Household Survey of Drug Abuse (NHSDA) between the years of 1996 and 1999. Linear regression models were used to investigate the effect of a state's clean indoor air (CIA) law (using a measure of extensiveness) on the overall amount of people who reported working in a smoke-free environment, youth smoking rates and adult smoking rates.

RESULTS

The extensiveness of a state's CIA law was found to be a reliable predictor of the percentage of indoor workers who report a smoke-free work environment and the rates of youth smoking. State CIA laws were not conclusively associated with adult smoking rates.

CONCLUSIONS

The extensiveness of a state's CIA law is strongly associated with a higher percentage of indoor workers reporting a smoke-free work environment. This study did not reveal a similar association between local laws and smoke-free work environments. Youth smoking rates, shown to be related to state CIA laws, may be further affected with more stringent CIA policy.

Value for taxpayers' dollars: what VA care would cost at medicare prices

Critics charge that Veterans Health Administration (VA) medical centers are inefficient and the cost of veteran health care would be reduced if VA purchased care for its patients directly from private-sector providers. This analysis compares VA medical care expenditures with estimates of total payments under a hypothetical Medicare fee-for-service payment system reimbursing providers for the same counts of each service VA medical centers provided in fiscal 1999. At six study sites, hypothetical payments were more than 20 percent greater than actual budgets. Nationally, this represented more than 3 billion US dollars in 1999 and more than 5 billion US dollars in 2003. Data limitations suggest the estimate is conservative. Less than half of the difference is due to VA's low pharmacy costs. The study demonstrates the potential savings to patients and taxpayers of the VA health care system.

Individual behaviours and substance use: the role of price

I discuss economic approaches to the demand for harmfully addictive substances with an emphasis on the role of money prices. First, I examine trends in the real prices and in the prevalence of the use of cigarettes, alcohol, cocaine, heroin, and marijuana in the U.S.A. Then I present estimates of time-series demand functions. Next, I discuss how economists have modified their traditional model of consumer behaviour to incorporate the addictive aspects of illegal substances. I conclude with implications for tax policy and for the lively and contentious debate concerning the legalization of marijuana, cocaine, and heroin.

Change In Challenging Times: A Plan For Extending And Improving Health Coverage

Some speculate that Americans are neither politically capable of nor morally committed to solving the health system problems. We disagree. We propose a plan that insures all and improves the value and cost-effectiveness of health care by knitting together employer-sponsored insurance and Medicaid; promoting prevention, research, and information technology; and financing its investments through a dedicated value-added tax. By prioritizing practicality, fairness, and responsibility, the plan aims to avoid ideological battles and prevent fear of major change. By emphasizing the moral imperative for change, especially relative to other options on the policy agenda, it aims to create momentum for expanding and improving health coverage for all.

Effects of water protection measures on the profitability of farms

The effect of different management measures on the nutrient losses from crop and animal husbandry systems, in particular nitrogen, and on the total income of model farming enterprises was investigated. Such measures are considered as powerful options for meeting the requirements of "cross compliance" within the Agenda 2000 midterm review of the CAP. Optimisation of the storage and handling of animal manure was shown to be the most important and cost effective measure to reduce nutrient losses on farms. Other measures such as protein and phosphorus adapted feeding, maintaining a year-round cover crop on arable land and conservation tillage were also effective and it is recommended that these are adopted into farming practices. In general, measures that have both a high potential to reduce nutrient losses and are cheap to apply, and therefore have little effect on the overall profitability of farms, should be given priority in water protection policies.