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ABSTRACT: BACKGROUND: Recent studies have found that Chinese smokers are relatively unresponsive to cigarette prices. As the Chinese government contemplates higher tobacco taxes, it is important to understand the reasons for this low response. One possible explanation is that smokers buffer themselves from rising cigarette prices by switching to cheaper cigarette brands. OBJECTIVE: This study examines how cigarette prices influence consumers' choices of cigarette brands in China. METHODS: This study uses panel data from the first three waves of the International Tobacco Control China Survey, drawn from six large cities in China and collected between 2006 and 2009. The study sample includes 3477 smokers who are present in at least two waves (8552 person-years). Cigarette brands are sorted by price into four tiers, using excise tax categories to determine the cut-off for each tier. The analysis relies on a conditional logit model to identify the relationship between price and brand choice. FINDINGS: Overall, 38% of smokers switched price tiers from one wave to the next. A ¥1 change in the price of cigarettes alters the tier choice of 4-7% of smokers. Restricting the sample to those who chose each given tier at baseline, a ¥1 increase in price in a given tier would decrease the share choosing that tier by 4% for Tier 1 and 1-2% for Tiers 2 and 3. CONCLUSIONS: China's large price spread across cigarette brands appears to alter the brand selection of some consumers, especially smokers of cheaper brands. Tobacco pricing and tax policy can influence consumers' incentives to switch brands. In particular, whereas ad valorem taxes in a tiered pricing system like China's encourage trading down, specific excise taxes discourage the practice.
Tobacco control 05/2013; · 3.85 Impact Factor
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ABSTRACT: This study estimated secondhand smoke (SHS) exposure at home among nonsmoking children (age 0-18) and adults (age ≥ 19) in rural China, and examined associated socio-demographic factors.
A total of 5,442 nonsmokers (including 1,456 children and 3,986 adults) living in six rural areas in China were interviewed in person. The standardized questionnaire obtained information on their demographic characteristics and SHS exposure at home. Differences in SHS exposure were assessed by use of the chi-squared test. Logistic regression analysis was used to examine the associated factors.
Occurrence of SHS exposure at home among nonsmoking children and adults was 68.0 and 59.3%, respectively. Logistic regression analysis found that children living in households with married, low-education, and low-income heads of household, and those who resided in the Qinghai province of China were more likely to be exposed to SHS. Among adults, those who were female, aged 19-34, single, low-education, and low-income, and those who lived in Qinghai province were more likely to be exposed to SHS at home.
Our findings of substantial SHS exposure at home in rural China emphasize the importance of implementing interventions to reduce SHS exposure among this population.
Cancer Causes and Control 03/2012; 23 Suppl 1:109-15. · 2.88 Impact Factor
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Tobacco control 12/2011; 21(3):381. · 3.85 Impact Factor
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ABSTRACT: Capitated Medicaid mental health programs have reduced costs over the short term by lowering the utilization of high-cost inpatient services. This study examined the five-year effects of capitated financing in community mental health centers (CMHCs) by comparing not-for-profit with for-profit programs.
Data were from the Medicaid billing system in Colorado for the precapitation year (1994) and a shadow billing system for the postcapitation years (1995-1999). In a panel design, a random-effect approach estimated the impact of two financing systems on service utilization and cost while adjusting for all the covariates.
Consistent with predictions, in both the for-profit and the not-for-profit CMHCs, relative to the precapitation year, there were significant reductions in each postcapitation year in high-cost treatments (inpatient treatment) for all but one comparison (not-for-profit CMHCs in 1999). Also consistent with predictions, the for-profit programs realized significant reductions in cost per user for both outpatient services and total services. In the not-for-profit programs, there were no significant changes in cost per user for total services; a significant reduction in cost per user for outpatient services was found only in the first two years, 1995 and 1996).
The evidence suggests that different strategies were used by the not-for-profit and for-profit programs to control expenditures and utilization and that the for-profit programs were more successful in reducing cost per user.
Psychiatric services (Washington, D.C.) 02/2011; 62(2):179-85. · 2.81 Impact Factor
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ABSTRACT: To estimate the health-related economic costs attributable to smoking in China for persons aged 35 and older in 2003 and in 2008 and to compare these costs with the respective results from 2000.
A prevalence-based, disease-specific approach was used to estimate smoking-attributable direct and indirect economic costs. The primary data source was the 2003 and 2008 China National Health Services Survey, which contains individual participant's smoking status, healthcare use and expenditures.
The total economic cost of smoking in China amounted to $17.1 billion in 2003 and $28.9 billion in 2008 (both measured in 2008 constant US$). Direct smoking-attributable healthcare costs in 2003 and 2008 were $4.2 billion and $6.2 billion, respectively. Indirect economic costs in 2003 and 2008 were $12.9 billion and $22.7 billion, respectively. Compared to 2000, the direct costs of smoking rose by 72% in 2003 and 154% in 2008, while the indirect costs of smoking rose by 170% in 2003 and 376% in 2008.
The economic burden of cigarette smoking has increased substantially in China during the past decade and is expected to continue to increase as the national economy and the price of healthcare services grow. Stronger intervention measures against smoking should be taken without delay to reduce the health and financial losses caused by smoking.
Tobacco control 02/2011; 20(4):266-72. · 3.85 Impact Factor
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ABSTRACT: Secondhand smoke (SHS) exposure harms pregnant women and the fetus. China has the world's largest number of smokers and a high male smoking prevalence rate.
To compare exposure to SHS among rural and urban Chinese non-smoking pregnant women with smoking husbands, and analyze factors associated with the level of SHS exposure and hair nicotine concentration.
Sichuan province, China.
In all 1,181 non-smoking pregnant women with smoking husbands recruited from eight district/county Women and Children's hospitals.
The women completed a questionnaire in April and May 2008. Based on systematic sampling, 186 pregnant women were selected for sampling the nicotine concentration in their hair. Ordinal logistic regression analysis was conducted to examine correlates with self-reported SHS exposure (total and at home); linear regression was conducted for the sub-sample of hair nicotine concentrations.
Secondhand smoking exposure rates, hair nicotine levels.
About 75.1% of the non-smoking pregnant women with smoking husbands reported regular SHS exposure. The major source of exposure was through their husband. In the multivariate analysis, the risk of greater SHS exposure (total and at home) and hair nicotine concentration was increased for women who were rural, had a husband with greater cigarette consumption, less knowledge about SHS, less negative attitudes about SHS, and no smoke-free home rules.
The high prevalence rate of SHS exposure suggests that it is important for non-smoking pregnant women, especially rural women, to establish smoke-free home rules and increase knowledge and negative attitudes towards SHS.
Acta Obstetricia Et Gynecologica Scandinavica 04/2010; 89(4):549-57. · 1.77 Impact Factor
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ABSTRACT: To identify key economic issues involved in raising the tobacco tax and to recommend possible options for tobacco tax reform in China.
Estimated 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.
The 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.
The 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.
Tobacco control 12/2009; 19(1):58-64. · 3.85 Impact Factor
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ABSTRACT: To compare the new tobacco tax structure effective from May 2009 with the tax structure before May 2009 and to analyse its potential impact.
Published government statistics and estimated price elasticities of the demand for cigarettes are used to estimate the impact of the new tax rate adjustment on cigarette consumption and population health.
The new adjustment increased the tax rate by 11.7% points at the producer price level. Converting this 11.7% point increase to the retail price level would mean an increase of 3.4% points in the retail price tax rate. Thus, China's new cigarette tax rate at the retail level would be 43.4% instead of the previous 40%.
The primary motivation for the recent Chinese government tobacco tax adjustment is to raise additional government revenue. Because the additional ad valorem tax has not yet been transferred to smokers, there is no public health benefit. It is hoped that the Chinese government will pass along these taxes to the retail price level, which would result in between 640,000 and two million smokers quitting smoking and between 210,000 and 700,000 quitters avoiding smoking-related premature death.
Tobacco control 10/2009; 19(1):80-2. · 3.85 Impact Factor
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ABSTRACT: Objective. To examine service cost and access for persons with severe mental illness under Medicaid mental health capitation payment in Colorado. Capitation contracts were made with two organizational models: community mental health centers (CMHCs) that manage and deliver services (direct capitation [DC]) and joint ventures between CMHCs and a for-profit managed care firm (managed behavioral health organization, [MBHO]) and compared to fee for service (F.F.S.).Data Sources/Study Setting. Both primary and secondary data were collected for the year prior to the new financing policy and the following two years (1995–1998).Study Design. A stratified random sample of 522 severely mentally ill subjects was selected from comparable geographic areas within the capitated and FFS regions of Colorado. Major variables include service cost, utilization, and access (probability of service use) derived from secondary claims data, subject reported access collected at six-month intervals, and baseline outcomes (symptoms, functioning, and quality of life).Principal Findings. In comparison to the FFS area, cost per person was reduced in the capitated areas in each of the two years following implementation. By the end of year two, cost per person was reduced by two-thirds in the MBHO areas and by one-fifth in the DC areas. Reductions in access were found for both capitated areas, although reductions in utilization for those receiving service were found only in the MBHO model.Conclusions. Medicaid mental health capitation in Colorado resulted in cost reducing service changes for persons with severe mental illness. Assessment of outcome change is necessary to identify cost effectiveness.
Health Services Research 09/2009; 37(2):315 - 340. · 2.16 Impact Factor
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ABSTRACT: To examine the secondhand smoke (SHS) exposure level in Chinese office buildings and to evaluate the effectiveness of a smoke-free policy in reducing SHS exposure.
Survey of smoking policies and measurement of SHS level in 14 office buildings from 10 provinces in China.
Smoking in the building significantly elevated the SHS concentrations both in offices with at least one smoker and in offices with no smokers. In one building that recently adopted a smoke-free policy, the nicotine concentrations decreased significantly after the policy was enacted. Enactment of a smoking policy was effective in reducing SHS exposure in the buildings.
Nonsmoking office workers in China were exposed to significant levels of SHS at work; both the central and local governments should realize the need to legislate against workplace smoking.
Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 06/2008; 50(5):570-5. · 1.88 Impact Factor
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ABSTRACT: To demonstrate cost-effectiveness analysis (CEA) for evaluating different reimbursement models.
The CEA used an observational study comparing fee for service (FFS) versus capitation for Medicaid cases with severe mental illness (n=522). Under capitation, services were provided either directly (direct capitation [DC]) by not-for-profit community mental health centers (CMHC), or in a joint venture between CMHCs and a for-profit managed behavioral health organization (MBHO).
A nonparametric matching method (genetic matching) was used to identify those cases that minimized baseline differences across the groups. Quality-adjusted life years (QALYs) were reported for each group. Incremental QALYs were valued at different thresholds for a QALY gained, and combined with cost estimates to plot cost-effectiveness acceptability curves.
QALYs were similar across reimbursement models. Compared with FFS, the MBHO model had incremental costs of -$1,991 and the probability that this model was cost-effective exceeded 0.90. The DC model had incremental costs of $4,694; the probability that this model was cost-effective compared with FFS was <0.10.
A capitation model with a for-profit element was more cost-effective for Medicaid patients with severe mental illness than not-for-profit capitation or FFS models.
Health Services Research 03/2008; 43(4):1204-22. · 2.16 Impact Factor
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ABSTRACT: To address the health hazards tobacco smoking imposes upon non-smokers in China, this paper estimates the burden of diseases in adults from passive tobacco smoking for two major diseases--lung cancer and ischaemic heart disease (IHD).
The disease burden was estimated in terms of both premature mortality and disability adjusted life years (DALYs), a measure that accounts for both the age at death and the severity of the morbidity.
Passive smoking caused more than 22,000 lung cancer deaths in 2002 according to these estimates. When the toll of disability is added to that of mortality, passive smoking was responsible for the loss of nearly 230,000 years of healthy life from lung cancer. Using the evidence from other countries that links IHD to passive smoking, we estimated that approximately 33,800 IHD deaths could be attributable to passive smoking in China in 2002. Passive smoking is also responsible for the loss of more than one quarter of a million years of healthy life from IHD. Although most of the disease burden caused by active smoking occurs among men, women bear nearly 80% of the total burden from passive smoking. The number of deaths among women caused by passive smoking is about two-thirds of that caused by smoking for the two diseases we examined.
Even without considering the passive smoking risks for other diseases and among children that have been documented in other countries, passive smoking poses serious health hazards for non-smokers, especially for adult female non-smokers in China, adding more urgency to the need for measures to be taken immediately to protect the health of non-smokers and curb the nation's tobacco epidemic.
Tobacco control 01/2008; 16(6):417-22. · 3.85 Impact Factor
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ABSTRACT: China has the most smokers among the world's nations. Physicians play a key role in smoking cessation, but little is known about Chinese physicians and smoking.
This 2004 clustered randomized survey of 3552 hospital-based physicians from six Chinese cities measured smoking attitudes, knowledge, personal behavior, and cessation practices for patients. Descriptive statistics and multivariate analysis of factors associated with asking about or advising against smoking were conducted in 2005 and 2006.
Smoking prevalence was 23% among all Chinese physicians, 41% for men and 1% for women. Only 30% report good implementation of smoke-free workplace policies and 37% of current smokers have smoked in front of their patients. Although 64% usually advise smokers to quit, only 48% usually ask about smoking status, and 29% believe most smokers will follow their cessation advice. Less than 7% set quit dates or use pharmacotherapy when helping smokers quit. Although 95% and 89%, respectively, know that active or passive smoking causes lung cancer, only 66% and 53%, respectively, know that active or passive smoking causes heart disease. Physicians were significantly more likely to ask about or advise against smoking if they believed that counseling about health harms helps smokers quit and that most smokers would follow smoking-cessation advice.
Physician smoking cessation, smoke-free workplaces, and education on smoking-cessation techniques need to be increased among Chinese physicians. Strengthening counseling skills may result in more Chinese physicians helping smoking patients to quit. These improvements can help reduce the Chinese and worldwide health burden from smoking.
American Journal of Preventive Medicine 08/2007; 33(1):15-22. · 4.04 Impact Factor
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ABSTRACT: A recent survey in China indicated the 12-month prevalence rate of depressive disorders was 2.5% in Beijing and 1.7% in Shanghai. These disorders may result in disability, premature death, and severe suffering of those affected and their families.
This study estimates the economic consequences of depressive disorders in China.
Depressive disorders can have both direct and indirect costs. To obtain direct costs, the research team interviewed 505 patients with depressive disorders and their caregivers in eight clinics/hospitals in five cities in China. Depression-related suicide rates were obtained from published literature. The human capital approach was used to estimate indirect costs. Epidemiological data were taken from available literature.
The total estimated cost of depression in China is 51,370 million Renminbi (RMB) (or US $6,264 million) at 2002 prices. Direct costs were 8,090 million RMB (or US$ 986 million), about 16% of the total cost of depression. Indirect costs were 43,280 million RMB (or US$ 5,278 million), about 84% of the total cost of depression.
Depression is a very costly disorder in China. The application of an effective treatment--reducing the length of depressive episodes (or preventing episodes) and reducing suicide rates--will lead to a significant reduction in the total burden resulting from depressive disorders. Government policymakers should seriously consider further investments in mental health services.
Social Psychiatry and Psychiatric Epidemiology 03/2007; 42(2):110-6. · 2.70 Impact Factor
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ABSTRACT: China produces about one-third of the world's supply of tobacco leaf and is the largest consumer of cigarettes. Any discussion of tobacco control in China requires an understanding of the government's role in this sector because China's tobacco production and cigarette marketing are all under the control of the State Tobacco Monopoly Administration. Compared to other cash crops, tobacco leaf has the lowest economic rate of return. Currently, China has a large surplus of tobacco leaf. One of the factors contributing to this surplus is local governments' encouraging farmers to plant tobacco leaf, in part because of their incentive of collecting tax revenue from tobacco leaf sales.
International Journal of Public Policy 02/2007; 2(3):235-248.
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ABSTRACT: Drawing on the 1998 China national health services survey data, this study estimated the poverty impact of two smoking-related expenses: excessive medical spending attributable to smoking and direct spending on cigarettes. The excessive medical spending attributable to smoking is estimated using a regression model of medical expenditure with smoking status (current smoker, former smoker, never smoker) as part of the explanatory variables, controlling for people's demographic and socioeconomic characteristics. The poverty impact is measured by the changes in the poverty head count, after smoking-related expenses are subtracted from income. We found that the excessive medical spending attributable to smoking may have caused the poverty rate to increase by 1.5% for the urban population and by 0.7% for the rural population. To a greater magnitude, the poverty headcount in urban and rural areas increased by 6.4% and 1.9%, respectively, due to the direct household spending on cigarettes. Combined, the excessive medical spending attributable to smoking and consumption spending on cigarettes are estimated to be responsible for impoverishing 30.5 million urban residents and 23.7 million rural residents in China. Smoking related expenses pushed a significant proportion of low-income families into poverty in China. Therefore, reducing the smoking rate appears to be not only a public health strategy, but also a poverty reduction strategy.
Social Science [?] Medicine 01/2007; 63(11):2784-90. · 2.70 Impact Factor
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Teh-wei Hu
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ABSTRACT: Mental illness is a major group of disorder that can lead to both physical and emotional disability. Policymakers need to learn not only the epidemiological indicators of mental illness, such as prevalence rate and incidence rate, but also the size of its negative impact on the economy.
This study is to review international publications on cost of major mental illness literature, from 1990 to 2003, focusing on the concepts, methods, and future perspective of cost illness studies. Reviewing the status quo on costs of mental illness can provide further information about gaps, limitations, and future needs on this topic.
This review searched all major international journals in psychiatry, clinical psychology, health economics, and mental health policy published since 1990. All national or aggregate cost of mental illness studies were included in the review. All were individually reviewed using a conceptual framework of cost of illness methodology.
A large majority of published cost of mental illness studies were conducted in the US and UK. Cost of illness studies were lacking from Africa, Asia, Eastern Europe, and Latin America. Empirical results from the reviewed studies indicate that the negative economic consequences of mental illness far exceed the direct costs of treatment, thus making it important to treat mental illness. Direct treatment costs for each mental disorder (i.e. depression, schizophrenia, dementia, etc.) is between 1% and 2% of total national health care costs.
The studies reviewed indicate great variation in cost estimates even for the same mental disorder during the same time period within a country. These wide variations may be due to differences in disorder classification, definition of cost categories, sample populations, data sources, and discounting rate. Given the limitations of the cost of illness studies reviewed, one should be careful in interpreting and using these estimated results. IMPLICATIONS FOR HEALTH SERVICES: These cost studies can be useful for understanding the magnitude of treating an illness of economic consequences or economic consequences of an illness for purposes of planning or budgeting. Such studies are one way to inform policymakers about economic consequences of mental illness.
The Journal of Mental Health Policy and Economics 04/2006; 9(1):3-13. · 0.97 Impact Factor
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ABSTRACT: This study investigated the impact of Colorado's Medicaid mental health managed care program on patterns of antipsychotic medication treatment among persons with a diagnosis of schizophrenia. These patterns were compared with patterns of psychosocial treatment and a measure of symptom change.
Changes in study measures over time in two areas of the state where the policy intervention was implemented were compared with changes in measures in areas where it was not implemented. The study sample consisted of 235 consumers. Measures of antipsychotic medication treatment included any use in a given period, months in which a prescription was filled, and use of second-generation antipsychotics. Psychosocial treatment was measured by any use and expenditures per user. The schizophrenia subscale of the Brief Psychiatric Rating Scale was used to measure consumer outcomes.
Probabilities of antipsychotic use in the managed care areas were stable or increased compared with the other areas. The average number of months with filled prescriptions was unchanged. Consumers served under managed care were less likely to use psychosocial treatment, and additional decreases in treatment costs were noted in one area. Difference scores for the schizophrenia subscale showed no change or positive effects for the managed care areas.
Within the Colorado managed care program, antipsychotic medication therapy was not impaired, despite significant decreases in the continuity or intensity of psychosocial treatment, and no reduction in symptom levels was noted. Mental health managed care does not inherently impair medication therapy. Patterns of medication use appeared to be better indicators of program success than psychosocial treatment patterns and were more consistent with outcomes.
Psychiatric Services 12/2005; 56(11):1402-8. · 2.38 Impact Factor
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ABSTRACT: Costs and cost-effectiveness of public sector substance abuse treatment in 2 California counties with similar substance abuse
treatment system histories are compared; one county (MidState) has adopted managed care principles. As hypothesized, MidState's
costs for the index treatment episode were significantly lower than SouthState's, although unexpectedly because of lower outpatient
utilization. Treatment benefits in the 7 Addiction Severity Index functional areas were examined through cost-effectiveness
analyses. MidState can claim greater cost-effectiveness for its treatment dollars for significant improvement in alcohol and
medical functioning (compared to unsuccessful clients and those reporting no problems). When comparing both improved clients
and those maintaining no problems to unsuccessful clients, MidState is more cost-effective for improving alcohol, medical,
legal, and family/social functioning; and 3 outcomes important to community stakeholders and taxpayers (legal, medical, and
psychiatric functioning) are more cost-effective than alcohol, drug, and employment improvement.
The Journal of Behavioral Health Services & Research 09/2005; 32(4):409-429. · 1.32 Impact Factor
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ABSTRACT: About 34 million people in the USA have an overactive bladder (OAB), a condition characterized by urinary urgency, with or without urinary incontinence, and usually frequency and nocturia. This condition is associated with increased health risks (e.g. urinary tract infection, falls and fall-related injuries, including broken bones), as well as admission to nursing homes and prolonged hospital stays. The annual costs associated with OAB in the community setting are >9 billion dollars, including 2.9 billion dollars for diagnosis and treatment, 1.5 billion dollars for routine care, 3.9 billion dollars for treatment of health-related consequences, and 841 million dollars in lost productivity. These cost patterns raise the possibility that treating OAB at an early stage may both improve patient care and minimize overall use of healthcare resources. However, before a thorough economic analysis of OAB can be undertaken, more data are needed about the long-term costs and the pathogenesis of OAB-related conditions.
BJU International 09/2005; 96 Suppl 1:43-5. · 2.84 Impact Factor
