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Paraje GR, Jha P, Savedoff W, Fuchs A. Taxation of tobacco, alcohol, and sugar-sweetened beverages: reviewing the evidence and dispelling the myths. BMJ Glob Health 2023; 8:e011866. [PMID: 37813440 PMCID: PMC10565262 DOI: 10.1136/bmjgh-2023-011866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/05/2023] [Indexed: 10/13/2023] Open
Abstract
The article reviews the large body of evidence on how taxation affects the consumption of tobacco, alcohol, and sugar-sweetened beverages (SSB). There is abundant evidence that demand for tobacco, alcohol, and SSB is price-responsive and that tax changes are quickly passed on to consumers. This suggests that taxes can be highly effective in changing consumption and reducing the burden of diseases associated with consuming these products. Tobacco, alcohol, and SSB industries oppose taxation on similar grounds, mostly on the regressivity of taxes since regressive taxes take a larger percentage of income from low income earners than from middle and high income earners; but also on the effects taxes might have on employment and economic activity; and, in the case of tobacco, the effects taxation has on illicit trade.Contrary to industry arguments, evidence shows that taxation may have short-term negative financial consequences for low-income households. However, medium and long-term financial benefits from reduced healthcare costs, better health, and welfare largely compensate for such consequences. Moreover, taxation does not negatively affect aggregate economic activity or employment, as consumers switch demand to other products that generate employment and may compensate for any employment loss in taxed sectors. Evidence also shows the revenues generated are generally spent on labour-intensive services. In the case of illicit trade in tobacco, evidence shows that illicit trade has not increased globally (rather the opposite) despite increases in tobacco taxes. Profit-maximising smugglers increase illicit cigarette prices along with the increases in licit cigarette prices. This implies that even when increased taxes divert some demand to the illicit market, they push prices up in the illicit market, discouraging consumption.
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Affiliation(s)
- Guillermo R Paraje
- Escuela de Negocios, Universidad Adolfo Ibáñez, Santiago de Chile, Chile
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Santiago de Chile, Chile
| | - Prabhat Jha
- CGHR, Centre for Global Health Research, St. Michael's Hospital and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Alan Fuchs
- World Bank, Washington, District of Columbia, USA
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Augustovski F, Bardach A, Santoro A, Rodriguez-Cairoli F, López-Osornio A, Argento F, Havela M, Blumenfeld A, Ballivian J, Solioz G, Capula A, López A, Cejas C, Savedoff W, Palacios A, Rubinstein A, Pichon-Riviere A. Publisher Correction: cost-effectiveness of COVID-19 vaccination in Latin America and the Caribbean: an analysis in Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, and Peru. Cost Eff Resour Alloc 2023; 21:56. [PMID: 37620882 PMCID: PMC10463684 DOI: 10.1186/s12962-023-00466-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Affiliation(s)
- Federico Augustovski
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy, Instituto de Efectividad Clínica y Sanitaria (IECS) - CONICET, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina.
| | - Ariel Bardach
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy, Instituto de Efectividad Clínica y Sanitaria (IECS) - CONICET, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Adrián Santoro
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy, Instituto de Efectividad Clínica y Sanitaria (IECS) - CONICET, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Federico Rodriguez-Cairoli
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy, Instituto de Efectividad Clínica y Sanitaria (IECS) - CONICET, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Alejandro López-Osornio
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Fernando Argento
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy, Instituto de Efectividad Clínica y Sanitaria (IECS) - CONICET, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Maissa Havela
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Alejandro Blumenfeld
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Jamile Ballivian
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy, Instituto de Efectividad Clínica y Sanitaria (IECS) - CONICET, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Germán Solioz
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy, Instituto de Efectividad Clínica y Sanitaria (IECS) - CONICET, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Analía Capula
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Analía López
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Cintia Cejas
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | - Alfredo Palacios
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy, Instituto de Efectividad Clínica y Sanitaria (IECS) - CONICET, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Adolfo Rubinstein
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Andrés Pichon-Riviere
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy, Instituto de Efectividad Clínica y Sanitaria (IECS) - CONICET, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
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Augustovski F, Bardach A, Santoro A, Rodriguez-Cairoli F, López-Osornio A, Argento F, Havela M, Blumenfeld A, Ballivian J, Solioz G, Capula A, López A, Cejas C, Savedoff W, Palacios A, Rubinstein A, Pichon-Riviere A. Cost-effectiveness of COVID-19 vaccination in Latin America and the Caribbean: an analysis in Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, and Peru. Cost Eff Resour Alloc 2023; 21:21. [PMID: 37005606 PMCID: PMC10066967 DOI: 10.1186/s12962-023-00430-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/08/2023] [Indexed: 04/04/2023] Open
Abstract
OBJECTIVE Our study analyzes the cost-effectiveness of the COVID-19 vaccination campaigns in Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, and Peru. METHODS Using a previously published SVEIR model, we analyzed the impact of a vaccination campaign (2021) from a national healthcare perspective. The primary outcomes were quality adjusted life years (QALYs) lost and total costs. Other outcomes included COVID-19 cases, hospitalizations, deaths, and life years. We applied a discount rate of 3% for health outcomes. We modeled a realistic vaccination campaign in each country (the realistic country-specific campaign). Additionally, we assessed a standard campaign (similar, "typical" for all countries), and an optimized campaign (similar in all countries with higher but plausible population coverage). One-way deterministic sensitivity analyses were performed. FINDINGS Vaccination was health improving as well as cost-saving in almost all countries and scenarios. Our analysis shows that vaccination in this group of countries prevented 573,141 deaths (508,826 standard; 685,442 optimized) and gained 5.07 million QALYs (4.53 standard; 6.03 optimized). Despite the incremental costs of vaccination campaigns, they had a total net cost saving to the health system of US$16.29 billion (US$16.47 standard; US$18.58 optimized). The realistic (base case) vaccination campaign in Chile was the only scenario, which was not cost saving, but it was still highly cost-effective with an ICER of US$22 per QALY gained. Main findings were robust in the sensitivity analyses. INTERPRETATION The COVID-19 vaccination campaign in seven Latin American and Caribbean countries -that comprise nearly 80% of the region- was beneficial for population health and was also cost-saving or highly cost-effective.
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Affiliation(s)
- Federico Augustovski
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department/ Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina.
| | - Ariel Bardach
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department/ Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Adrián Santoro
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Federico Rodriguez-Cairoli
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department/ Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Alejandro López-Osornio
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Fernando Argento
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department/ Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Maissa Havela
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Alejandro Blumenfeld
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Jamile Ballivian
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department/ Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Germán Solioz
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department/ Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Analía Capula
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Analía López
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Cintia Cejas
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | - Alfredo Palacios
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department/ Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Adolfo Rubinstein
- Centro de Implementación e Innovación en Políticas de Salud (CIIPS). Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Andrés Pichon-Riviere
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud/Health Technology Assessment and Health Economics Department/ Instituto de Efectividad Clínica y Sanitaria (IECS)/Institute for Clinical Effectiveness and Health Policy, Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
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Raifman J, Lam F, Keller JM, Radunsky A, Savedoff W. How well are aid agencies evaluating programs? An assessment of the quality of global health evaluations. J Dev Effect 2018; 10:277-289. [PMID: 30275927 PMCID: PMC6161748 DOI: 10.1080/19439342.2018.1452779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Evaluations are key to learning and accountability. We assessed the methodological quality of 37 randomly selected programme evaluations from 5 major global health funders. Two researchers rated each evaluation for relevance, validity, and reliability and met to resolve discrepancies. Most evaluations asked questions relevant to the health programme, but less than 40 per cent of impact evaluations and less than 10 per cent of performance evaluations used relevant data, followed accepted social science methods for sampling, or had high analytical validity and reliability. There is a need to improve the methodological quality of programme evaluations.
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Affiliation(s)
- Julia Raifman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Felix Lam
- Monitoring and Evaluation, Clinton Health Access Initiative, Boston, MA, USA
| | | | - Alexander Radunsky
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Sekhri N, Savedoff W. Regulating private health insurance to serve the public interest: policy issues for developing countries. Int J Health Plann Manage 2006; 21:357-92. [PMID: 17175735 DOI: 10.1002/hpm.857] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Private health insurance plays a large and increasing role around the world. This paper reviews international experiences and shows that private health insurance is significant in countries with widely different income levels and health system structures. It contrasts trends in private health insurance expansion across regions and highlights countries with particularly important experiences of private coverage. It then discusses the regulatory approaches and policies that can structure private health insurance markets in ways that mobilize resources for health care, promote financial risk protection, protect consumers and reduce inequities. The paper argues that policy makers need to confront the role that private health insurance will play in their health systems and regulate the sector appropriately so that it serves public goals of universal coverage and equity.
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Affiliation(s)
- Neelam Sekhri
- Health Finance and Policy Advisor, World Health Organization, Switzerland.
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James C, Carrin G, Savedoff W, Hanvoravongchai P. Clarifying Efficiency-Equity Tradeoffs Through Explicit Criteria, With a Focus on Developing Countries. Health Care Anal 2005; 13:33-51. [PMID: 15889680 DOI: 10.1007/s10728-005-2568-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Expenditures on health in many developing countries are being disproportionately spent on health services that have a low overall health impact, and that disproportionately benefit the rich. Without explicit consideration of priority setting, this situation is likely to remain unchanged: resource allocation is too often dictated by historical patterns, and maintains vested interests. This paper explores how prioritization between different health interventions can be rationalised by the use of clearly defined criteria. A number of key efficiency and equity criteria are examined, in particular analysing how potential tradeoffs could be incorporated into the decision making process.
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Affiliation(s)
- Chris James
- Department of Health System Financing, Expenditure and Resource Allocation, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland.
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Sekhri N, Savedoff W. Private health insurance: implications for developing countries. Bull World Health Organ 2005; 83:127-134. [PMID: 15744405 PMCID: PMC2623814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
Private health insurance is playing an increasing role in both high- and low-income countries, yet is poorly understood by researchers and policy-makers. This paper shows that the distinction between private and public health insurance is often exaggerated since well regulated private insurance markets share many features with public insurance systems. It notes that private health insurance preceded many modern social insurance systems in western Europe, allowing these countries to develop the mechanisms, institutions and capacities that subsequently made it possible to provide universal access to health care. We also review international experiences with private insurance, demonstrating that its role is not restricted to any particular region or level of national income. The seven countries that finance more than 20% of their health care via private health insurance are Brazil, Chile, Namibia, South Africa, the United States, Uruguay and Zimbabwe. In each case, private health insurance provides primary financial protection for workers and their families while public health-care funds are targeted to programmes covering poor and vulnerable populations. We make recommendations for policy in developing countries, arguing that private health insurance cannot be ignored. Instead, it can be harnessed to serve the public interest if governments implement effective regulations and focus public funds on programmes for those who are poor and vulnerable. It can also be used as a transitional form of health insurance to develop experience with insurance institutions while the public sector increases its own capacity to manage and finance health-care coverage.
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Affiliation(s)
- Neelam Sekhri
- World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland.
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