1
|
Li MQ, Zhang Y. Emigration and fiscal gap in population-exporting region. PLoS One 2024; 19:e0302928. [PMID: 38713718 DOI: 10.1371/journal.pone.0302928] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 04/16/2024] [Indexed: 05/09/2024] Open
Abstract
This paper analyzes how emigration impacts fiscal gap of population-exporting region in the long term. We construct a general equilibrium model of emigration and fiscal gap and make empirical verification using two-step system GMM model. Among the major lessons from this work, five general and striking results are worth highlighting: (1) the economic losses of emigration are the immediate cause of widening the fiscal gap. (2) in the short and long term, emigration can expand the fiscal revenue gap through the superimposed effect of tax rate and tax base. (3) the gap in fiscal expenditure is widened by the outflow of people in the short term. However, local governments would change the strategy to keep the spending gap from widening in the long run. (4) a positive impact of emigration on the fiscal gap. the more severe population emigration, the larger the fiscal gap. (5) when the trend of emigration becomes irreversible, the subsequent efforts of local governments to expand fiscal expenditure for attraction population would not only fail to revive the regional economy, but aggravate the expansion of fiscal gap. The contribution of research is twofold. On the one hand, it fills the theoretical gap between emigration and fiscal gap because previous studies have paid little attention to the fiscal problems of local government of population outflow. On the other hand, the selection of Northeast China that has been subject to long-term out-of-population migration is good evidence to verify this theory, which is tested very well using the 2S-GMM model. The comprehensive discussion on the relationship between emigration and fiscal gap is helpful to guide those continuous population-exporting regions that are facing a huge fiscal gap how to solve the fiscal gap and unsustainability from the perspective of fiscal revenue and expenditure.
Collapse
Affiliation(s)
- Mei-Qi Li
- School of Taxation, Jilin University of Finance and Economics, Changchun, Jilin, P. R. China
| | - Yong Zhang
- School of Electronic Information Engineering, Changchun University of Science and Technology, Changchun, Jilin, P. R. China
| |
Collapse
|
2
|
Spencer G, Nugent R, Mann N, Hutchinson B, Ngongo C, Tarlton D, Small R, Webb D. Equity implications of tobacco taxation: results from WHO FCTC investment cases. Tob Control 2024; 33:s27-s33. [PMID: 38697660 DOI: 10.1136/tc-2023-058338] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/19/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Across time, geographies and country income levels, smoking prevalence is highest among people with lower incomes. Smoking causes further impoverishment of those on the lower end of the income spectrum through expenditure on tobacco and greater risk of ill health. METHODS This paper summarises the results of investment case equity analyses for 19 countries, presenting the effects of increased taxation on smoking prevalence, health and expenditures. We disaggregate the number of people who smoke, smoking-attributable mortality and cigarette expenditures using smoking prevalence data by income quintile. A uniform 30% increase in price was applied across countries. We estimated the effects of the price increase on smoking prevalence, mortality and cigarette expenditures. RESULTS In all but one country (Bhutan), a one-time 30% increase in price would reduce smoking prevalence by the largest percent among the poorest 20% of the population. All income groups in all countries would spend more on cigarettes with a 30% increase in price. However, the poorest 20% would pay an average of 12% of the additional money spent. CONCLUSIONS Our results confirm that health benefits from increases in price through taxation are pro-poor. Even in countries where smoking prevalence is higher among wealthier groups, increasing prices can still be pro-poor due to variable responsiveness to higher prices. The costs associated with higher smoking prevalence among the poor, together with often limited access to healthcare services and displaced spending on basic needs, result in health inequality and perpetuate the cycle of poverty.
Collapse
Affiliation(s)
| | - Rachel Nugent
- RTI International, Research Triangle Park, North Carolina, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Nathan Mann
- RTI International, Research Triangle Park, North Carolina, USA
| | | | - Carrie Ngongo
- RTI International, Research Triangle Park, North Carolina, USA
| | | | - Roy Small
- HIV, Health and Development Group, United Nations Development Programme, New York, New York, USA
| | - Douglas Webb
- United Nations Development Programme, Amman, Jordan
| |
Collapse
|
3
|
Purtle J, Stadnick NA, Wynecoop M, Walker SC, Bruns EJ, Aarons GA. A Tale of Two Taxes: Implementation of Earmarked Taxes for Behavioral Health Services in California and Washington State. Psychiatr Serv 2024; 75:410-418. [PMID: 37933132 DOI: 10.1176/appi.ps.20230257] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
OBJECTIVE The authors sought to characterize perceptions of the impacts, attributes, and support for taxes earmarked for behavioral health services and to compare perceptions of the taxes among professionals in California and Washington, two states differing in earmarked tax designs. METHODS Surveys were completed by 155 public agency and community organization professionals involved in tax implementation in California (N=87) and Washington State (N=68) during 2022-2023 (29% response rate). Respondents indicated their perceptions of the taxes' impacts, attributes, and support. Responses were summed as aggregate scores and were also analyzed as individual items. Bivariate analyses were used to compare responses of professionals in California versus Washington State. RESULTS Earmarked taxes were generally regarded positively. Of the respondents, >80% strongly agreed that the taxes increased funding for services and were helpful, and only 10% strongly agreed that the taxes decreased behavioral health funding from other sources. Substantially more respondents in California than in Washington State strongly agreed that taxes' reporting requirements were complicated (45% vs. 5%, p<0.001) and that the taxes increased unjustified scrutiny of services or systems (33% vs. 2%, p<0.001). However, more respondents in California than in Washington State also strongly agreed that the taxes increased public awareness about behavioral health (56% vs. 15%, p<0.001) and decreased behavioral health stigma (47% vs. 14%, p<0.001). CONCLUSIONS Perceptions of the strengths and weaknesses of taxes earmarked for behavioral health services may vary by design features of the tax. Such features include stigma-reduction initiatives and tax spending and reporting requirements.
Collapse
Affiliation(s)
- Jonathan Purtle
- Global Center for Implementation Science, Department of Public Health Policy and Management, New York University School of Global Public Health, New York City (Purtle, Wynecoop); Dissemination and Implementation Science Center, Department of Psychiatry, Altman Clinical and Translational Research Institute, University of California, San Diego, La Jolla (Stadnick, Aarons); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Walker, Bruns)
| | - Nicole A Stadnick
- Global Center for Implementation Science, Department of Public Health Policy and Management, New York University School of Global Public Health, New York City (Purtle, Wynecoop); Dissemination and Implementation Science Center, Department of Psychiatry, Altman Clinical and Translational Research Institute, University of California, San Diego, La Jolla (Stadnick, Aarons); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Walker, Bruns)
| | - Megan Wynecoop
- Global Center for Implementation Science, Department of Public Health Policy and Management, New York University School of Global Public Health, New York City (Purtle, Wynecoop); Dissemination and Implementation Science Center, Department of Psychiatry, Altman Clinical and Translational Research Institute, University of California, San Diego, La Jolla (Stadnick, Aarons); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Walker, Bruns)
| | - Sarah C Walker
- Global Center for Implementation Science, Department of Public Health Policy and Management, New York University School of Global Public Health, New York City (Purtle, Wynecoop); Dissemination and Implementation Science Center, Department of Psychiatry, Altman Clinical and Translational Research Institute, University of California, San Diego, La Jolla (Stadnick, Aarons); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Walker, Bruns)
| | - Eric J Bruns
- Global Center for Implementation Science, Department of Public Health Policy and Management, New York University School of Global Public Health, New York City (Purtle, Wynecoop); Dissemination and Implementation Science Center, Department of Psychiatry, Altman Clinical and Translational Research Institute, University of California, San Diego, La Jolla (Stadnick, Aarons); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Walker, Bruns)
| | - Gregory A Aarons
- Global Center for Implementation Science, Department of Public Health Policy and Management, New York University School of Global Public Health, New York City (Purtle, Wynecoop); Dissemination and Implementation Science Center, Department of Psychiatry, Altman Clinical and Translational Research Institute, University of California, San Diego, La Jolla (Stadnick, Aarons); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Walker, Bruns)
| |
Collapse
|
4
|
|
5
|
Parolin Z, Giupponi G, Lee EK, Collyer S. Consumption responses to an unconditional child allowance in the United States. Nat Hum Behav 2024; 8:657-667. [PMID: 38374443 PMCID: PMC11045438 DOI: 10.1038/s41562-024-01835-6] [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: 01/17/2023] [Accepted: 01/16/2024] [Indexed: 02/21/2024]
Abstract
The COVID-19 pandemic put families in the United States under financial stress. The federal government's largest response in 2021 was the American Rescue Plan Act, which temporarily expanded the Child Tax Credit (CTC) into a large, unconditional child allowance providing monthly payments to families with children. This study investigates consumption responses to the CTC expansion using anonymized mobile-location data and debit/credit card data that track visits and spending at 1.3 million establishments across US counties. For identification, we exploit variation in the size of households' income gains due to the CTC across counties in a difference-in-differences framework spanning January 2021 to May 2022. Counties benefiting most from the CTC expansion experienced larger increases in visits to childcare centres and health- and personal-care establishments, and increased visits to and spending per transaction at grocery and general stores. These findings suggest that the CTC expansion increased household consumption and spending on children.
Collapse
Affiliation(s)
- Zachary Parolin
- Department of Social and Political Sciences, Bocconi University, Milan, Italy.
| | - Giulia Giupponi
- Department of Social and Political Sciences, Bocconi University, Milan, Italy
| | - Emma K Lee
- Opportunity Insights, Harvard University, Cambridge, MA, USA
| | - Sophie Collyer
- Center on Poverty and Social Policy, Columbia University, New York, NY, USA
| |
Collapse
|
6
|
He Y, Fong GT, Cummings KM, Hyland A, Shang C. The association between excise taxes and smoking and vaping transitions-Findings from the 2016-2020 ITC United States surveys. Int J Drug Policy 2024; 126:104372. [PMID: 38422713 DOI: 10.1016/j.drugpo.2024.104372] [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: 09/27/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND While a growing number of studies examined the effect of e-cigarette (EC) excise taxes on tobacco use behaviors using cross-sectional surveys or sales data, there are currently no studies that evaluate the impact of EC taxes on smoking and vaping transitions. METHODS Using data from the US arm of the 2016-2020 International Tobacco Control Four Country Smoking and Vaping Survey (ITC 4CV), we employed a multinomial logit model with two-way fixed effects to simultaneously estimate the impacts of cigarette/EC taxes on the change in smoking and vaping frequencies. RESULTS Our benchmark model suggests that a 10 % increase in cigarette taxes led to an 11 % reduction in smoking frequencies (p < 0.01), while EC taxes did not have a significant effect on smoking frequencies. CONCLUSION Our findings suggest that increasing cigarette taxes may serve as an effective means of encouraging people who smoke to cut back on smoking or quit smoking. The impact of increasing EC taxes on smoking transitions is less certain at this time.
Collapse
Affiliation(s)
- Yanyun He
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada; School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Andrew Hyland
- Department of Health Behaviors, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, USA
| | - Ce Shang
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Internal Medicine, Medical Oncology Division, The Ohio State University, Columbus, OH, USA
| |
Collapse
|
7
|
Qian B. Financial subsidies, tax incentives, and new energy vehicle enterprises' innovation efficiency: Evidence from Chinese listed enterprises. PLoS One 2023; 18:e0293117. [PMID: 37878645 PMCID: PMC10599573 DOI: 10.1371/journal.pone.0293117] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/25/2023] [Indexed: 10/27/2023] Open
Abstract
Financial subsidies and tax incentives play essential roles in the innovation efficiency of enterprises. This paper selects Chinese listed NEV enterprises from 2010 to 2022 as a research sample and investigates various impacts under various circumstances. We find that both financial subsidies and tax incentives can promote the innovation efficiency of NEV enterprises. Compared to financial subsidies, tax incentives are more effective; the interaction between financial subsidies and tax incentives has a weaker impact on the innovation efficiency of NEV enterprises. Both financial subsidies and tax incentives have more potent innovation effects on enterprises with higher financing constraints. In addition, financial subsidies and tax incentives have a stronger innovation efficiency effect on private enterprises than state-owned enterprises. Further research shows that marketization and market distortion affect the innovation efficiency of NEV enterprises. This study provides a new perspective for understanding the effects of financial subsidies, tax incentives, and innovation efficiency of NEV enterprises, and the conclusions and suggestions are relevant references for the government to improve the quality of policy-making.
Collapse
Affiliation(s)
- Binhua Qian
- School of Economy and Management, Zhejiang Business Technology Institute, Ningbo, China
| |
Collapse
|
8
|
Lu N, Zhou W. The impact of green taxes on green innovation of enterprises: a quasi-natural experiment based on the levy of environmental protection taxes. Environ Sci Pollut Res Int 2023; 30:92568-92580. [PMID: 37491497 DOI: 10.1007/s11356-023-28718-z] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/05/2023] [Indexed: 07/27/2023]
Abstract
Green innovation is a strategic choice for Chinese enterprises to achieve in balancing economic performance and environmental benefits. Environmental protection tax (EPT) is the first green tax in China. How to fully leverage the institutional dividends of environmental tax reform to achieve green innovation in enterprises is of great significance for the high-quality development of China's current economy. This study takes the levy of environmental protection taxes as the quasi-natural experiment and uses DID, DDD, PSM-DID and so on to verify the impact of EPT on green innovation. The results show that EPT can improve green innovation through the path of legitimacy pressure and legitimacy management. Notably, the effects are more obvious in enterprises with non-state-owned, low-financing constraints and located in the eastern region. Furthermore, green innovations under the push of environmental protection tax can improve long-term performance, while it has a negative effect on short-term performance. The levy of EPT has the dual dividend effect of economy and environment. Moreover, this study explores the source of the legitimacy pressure and the strategic response of enterprises and provides guidance for government's precise implementation of policies to optimize the role of EPT in green innovation.
Collapse
Affiliation(s)
- Na Lu
- School of Economics and Management, Qujing Normal University, Qujing, 655000, China
- School of Business School, Yunnan University of Finance and Economics, Kunming, 650000, China
| | - Wei Zhou
- School of Finance, Yunnan University of Finance and Economics, Kunming, 650000, China.
| |
Collapse
|
9
|
Abstract
In 2016, China implemented an environmental protection tax (EPTL2016) to promote the transformation and upgrading of heavily polluting industries through tax leverage. Using panel data of China’s listed companies, this study assesses the treatment effects of the EPTL2016 on the transformation and upgrading of heavily polluting firms by incorporating the intermediary role of the financial market. The empirical findings show that the EPTL2016 significantly reduced the innovation investment and productivity of heavily polluting firms but had no significant effect on fixed-asset investment. Additionally, EPTL2016 reduced the supply of bank loans to heavily polluting firms and increased the value of growth options for private enterprises and the efficiency of the supply of long-term loans to heavily polluting firms. Although the environmental policy of EPTL2016 benefits the transformation and upgrading of heavily polluting industries in many aspects, it generally hinders the industrial upgrading because of the reduction of bank loans.
Collapse
Affiliation(s)
- Huwei Wen
- Research Center of the Central China for Economic and Social Development, Nanchang University, Nanchang, Jiangxi, China
- Department of Economics, School of Economics and Management, Nanchang University, Nanchang, Jiangxi, China
| | - Weifeng Deng
- Department of Economics, School of Economics and Management, Nanchang University, Nanchang, Jiangxi, China
| | - Quanen Guo
- Department of Tourism Management, School of Tourism, Nanchang University, Nanchang, Jiangxi, China
- * E-mail:
| |
Collapse
|
10
|
Abstract
BACKGROUND Tobacco consumption is one of the leading causes of preventable death. In this study, we analyze whether someone's genetic predisposition to smoking moderates the response to tobacco excise taxes. METHODS We interact polygenic scores for smoking behavior with state-level tobacco excise taxes in longitudinal data (1992-2016) from the US Health and Retirement Study (N = 12,058). RESULTS Someone's genetic propensity to smoking moderates the effect of tobacco excise taxes on smoking behavior along the extensive margin (smoking vs. not smoking) and the intensive margin (the amount of tobacco consumed). In our analysis sample, we do not find a significant gene-environment interaction effect on smoking cessation. CONCLUSIONS When tobacco excise taxes are relatively high, those with a high genetic predisposition to smoking are less likely (i) to smoke, and (ii) to smoke heavily. While tobacco excise taxes have been effective in reducing smoking, the gene-environment interaction effects we observe in our sample suggest that policy makers could benefit from taking into account the moderating role of genes in the design of future tobacco control policies.
Collapse
Affiliation(s)
- Eric A. W. Slob
- MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- Department of Applied Economics, Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus University Rotterdam Institute for Behavior and Biology, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Cornelius A. Rietveld
- Department of Applied Economics, Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus University Rotterdam Institute for Behavior and Biology, Erasmus University Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
11
|
Abstract
IMPORTANCE Adults and children routinely exceed recommended intake amounts of added sugars established by dietary guidelines. Taxes are used as a policy tool to reduce demand for sugar-sweetened beverages (SSBs) given consumption-related adverse health outcomes but may induce substitution to other sources of added sugars. OBJECTIVE To examine the extent to which changes in grams of sugar sold from taxed beverages may be offset by changes in grams of sugar sold from untaxed beverages, sweets, and stand-alone sugar after the implementation of the Seattle, Washington, Sweetened Beverage Tax (SBT) on January 1, 2018. DESIGN, SETTING, AND PARTICIPANTS This study used difference-in-differences analyses to examine changes in grams of sugar sold from taxed and untaxed products in Seattle compared with Portland, Oregon, at year 1 and year 2 post tax. This study used Nielsen scanner data from supermarkets and mass merchandise as well as grocery, drug, convenience, and dollar stores on unit sales and measurements for beverage and food product universal product codes (UPCs) for each site for the pretax period (January 8-December 30, 2017) and the corresponding weeks in year 1 post tax (2018) and in year 2 post tax (2019). Nutritional analyses assessed grams of sugar for each UPC. The analytical balanced sample included 1326 taxed beverage UPCs, 239 untaxed beverage UPCs, 2054 sweets UPCs, and 81 stand-alone sugar UPCs. Statistical analysis was performed from January to August 2021. EXPOSURES Implementation of the Seattle SBT. MAIN OUTCOMES AND MEASURES Changes in grams of sugar sold from taxed beverages, untaxed beverages, sweets, and stand-alone sugar. RESULTS At both year 1 and year 2 post tax in Seattle compared with Portland, grams of sugar sold from taxed beverages decreased 23% (year 2 posttax ratio of incidence rate ratios [RIRR] = 0.77; 95% CI, 0.73-0.80). Sugar sold from untaxed beverages increased at year 1 post tax by 4% (RIRR = 1.04; 95% CI, 1.00-1.07) with no change at year 2 post tax. Sugar sold from sweets increased by 4% at both year 1 and year 2 post tax (year 2 posttax RIRR = 1.04; 95% CI, 1.03-1.06). There were no changes in stand-alone sugar sold. CONCLUSIONS AND RELEVANCE This study using difference-in-differences analysis found a net 19% reduction in grams of sugar sold from taxed SSBs at year 2 post tax after accounting for changes in sugar sold from untaxed beverages, sweets, and stand-alone sugar. These results suggest that SSB taxes may effectively yield permanent reductions in added sugars sold from SSBs in food stores.
Collapse
Affiliation(s)
- Lisa M. Powell
- Division of Health Policy and Administration, University of Illinois Chicago School of Public Health, Chicago
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago
| | - Vanessa M. Oddo
- Department of Kinesiology and Nutrition, University of Illinois Chicago College of Applied Health Sciences, Chicago
| |
Collapse
|
12
|
Chrisinger BW. Philadelphia's Excise Tax on Sugar-Sweetened and Artificially Sweetened Beverages and Supplemental Nutrition Assistance Program Benefit Redemption. Am J Public Health 2021; 111:1986-1996. [PMID: 34678053 PMCID: PMC8630475 DOI: 10.2105/ajph.2021.306464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To assess the effect of a 2017 excise tax on sugar and artificially sweetened beverages in Philadelphia, Pennsylvania, on the shopping patterns of low-income populations using Supplemental Nutrition Assistance Program (SNAP) data. Methods. I used a synthetic controls approach to estimate the effect of the tax on Philadelphia and neighboring Pennsylvania counties (Bucks, Delaware, and Montgomery) as measured by total SNAP sales ("SNAP redemption") and SNAP redemption per SNAP participant. I assembled biannual data (2005-2019) from all US counties for SNAP redemption and relevant predictors. I performed placebo tests to estimate statistically significant effects and conducted robustness checks. Results. Detectable increases in SNAP spending occurred in all 3 Philadelphia neighboring counties. Per-participant SNAP spending increased in 2 of the neighboring counties and decreased in Philadelphia. These effects were robust across multiple specifications and placebo tests. Conclusions. The tax contributed to increased SNAP shopping in Philadelphia's neighboring counties across both outcome measures, and decreased spending in Philadelphia (at least by 1 measure). This raises questions about retailer behavior, the effectiveness of the tax's public health aim of reducing sugar-sweetened beverage consumption, and policy aims of investing in low-income communities. (Am J Public Health. 2021;111(11):1986-1996. https://doi.org/10.2105/AJPH.2021.306464).
Collapse
Affiliation(s)
- Benjamin W Chrisinger
- Benjamin W. Chrisinger is with the Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
13
|
Gunadi C, Benmarhnia T, White M, Pierce JP, McMenamin SB, Leas EC, Shi Y. Tobacco price and use following California Proposition 56 tobacco tax increase. PLoS One 2021; 16:e0257553. [PMID: 34644338 PMCID: PMC8513910 DOI: 10.1371/journal.pone.0257553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/03/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND California Proposition 56 increased cigarette excise tax by $2 per pack with equivalent increases on non-cigarette tobacco products. We estimated the changes in cigarette price, cigarette use, and non-cigarette use following the implementation of Proposition 56 in California in 2017. METHODS Seven waves of Tobacco Use Supplements to the Current Population Survey (TUS-CPS) 2011-2019 data were used to obtain state-level aggregate self-reported outcomes, including cigarette price per pack, current and daily cigarette use, cigarette consumption per day, and current and daily use of non-cigarette tobacco products (hookah, pipe, cigar, and smokeless tobacco). A modified version of a synthetic control method was used to create a "synthetic" California that best resembled pre-policy sociodemographic characteristics and outcome trends in California while correcting time-invariant pre-policy differences. Various sensitivity analyses were also conducted. RESULTS The implementation of Proposition 56 was associated with an increase in self-reported cigarette price per pack in California ($1.844, 95%CI: $0.153, $3.534; p = 0.032). No evidence suggested that Proposition 56 was associated with the changes in the prevalence of current or daily cigarette use, cigarette consumption per day, or the prevalence of current or daily use of non-cigarette tobacco products. CONCLUSION Most of the cigarette tax increase following Proposition 56 in California was passed on to consumers. There is a lack of evidence that the implementation of Proposition 56 was associated with the changes in the use of cigarettes and other tobacco products such as hookah, pipe, cigar, and smokeless tobacco.
Collapse
Affiliation(s)
- Christian Gunadi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, United States of America
| | - Tarik Benmarhnia
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, United States of America
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, California, United States of America
| | - Martha White
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, United States of America
| | - John P. Pierce
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, United States of America
| | - Sara B. McMenamin
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, United States of America
| | - Eric C. Leas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, United States of America
| | - Yuyan Shi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, United States of America
| |
Collapse
|
14
|
Teng A, Puloka V, Signal L, Wilson N. Pacific countries lead the way on sugary drinks taxes: lessons for New Zealand. N Z Med J 2021; 134:137-140. [PMID: 34695085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Andrea Teng
- Senior Research Fellow, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Viliami Puloka
- Research Fellow, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Louise Signal
- Head of Department, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nick Wilson
- Professor, Department of Public Health, University of Otago, Wellington, New Zealand
| |
Collapse
|
15
|
Apenteng BA, Opoku ST, Owens C, Akowuah E, Kimsey L, Peden A. Assessment of the Financial Health of Rural Hospitals After Implementation of the Georgia Rural Hospital Tax Credit Program. JAMA Netw Open 2021; 4:e2117791. [PMID: 34297073 PMCID: PMC8303099 DOI: 10.1001/jamanetworkopen.2021.17791] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE In 2016, Georgia implemented the Rural Hospital Tax Credit Program, which allows taxpayers to receive a tax credit for contributions to qualifying rural hospitals in the state. Empirical evidence of the program's association with the viability of the state's rural hospitals is needed. OBJECTIVE To examine the association of the tax credit program with the financial health of participating rural hospitals. DESIGN, SETTING, AND PARTICIPANTS This longitudinal cross-sectional study used hospital financial data from the Centers for Medicare & Medicaid Services for 2015 to 2019. A difference-in-differences analytic approach was used to examine the association of the tax credit program with rural hospital financial health. Study participants included Georgia rural hospitals eligible to participate in the program. Comparison hospitals were selected from the southern states of Alabama, Florida, Mississippi, North Carolina, South Carolina, and Tennessee. EXPOSURES Hospital participation in the Georgia Rural Hospital Tax Credit Program. MAIN OUTCOMES AND MEASURES The primary outcome of the study was financial health measured with total margin, days cash on hand, debt-asset ratio, and average age of plant as well as a Financial Strength Index (FSI), which combined the previous measures to assess overall financial strength. RESULTS The analytical sample included a balanced panel of 136 hospitals, with 47 Georgia Rural Hospital Tax Credit Program participants (18 [38%] critical access hospitals; 5 [11%] system affiliated; mean [SD] bed count, 60 [47]; mean [SD] Medicare inpatient mix, 52% [16]) and 89 comparison hospitals (43 [48%] critical access hospitals; 24 [27%] system affiliated; mean [SD] bed count, 52 [41]; mean [SD] Medicare inpatient mix, 67% [18]). Two years after implementation, program participation was associated with a 23% increased probability of good or excellent financial health (b = 0.23; 95% CI, 0.10-0.37; P < .001) and a 6.7-point increase in total margin (b = 6.67; 95% CI, 3.61-9.73; P < .001). CONCLUSIONS AND RELEVANCE These early findings suggest that the Georgia Rural Hospital Tax Credit Program is associated with improvements in hospital financial health; however, additional studies are needed to assess the program's long-term impact on the financial sustainability of Georgia's rural hospitals.
Collapse
Affiliation(s)
- Bettye A. Apenteng
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro
| | - Samuel T. Opoku
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro
| | - Charles Owens
- Center for Public Health Practice and Research, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro
| | | | - Linda Kimsey
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro
| | - Angie Peden
- Center for Public Health Practice and Research, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro
| |
Collapse
|
16
|
De Cristofaro V, Giacomantonio M, Pellegrini V, Salvati M, Leone L. Being mindful in the tax context in Italy: Examining whether and how mindfulness relates with tax evasion intentions and support for tax progressivity. PLoS One 2021; 16:e0253627. [PMID: 34170947 PMCID: PMC8232402 DOI: 10.1371/journal.pone.0253627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/09/2021] [Indexed: 11/25/2022] Open
Abstract
Two studies explored whether and how mindfulness relates with citizens’ tax evasion intentions and support for progressive tax rates. Based on theoretical and empirical grounds, in Study 1 (N = 1,175) we proposed that mindfulness would be negatively related with tax evasion intentions through decreased social dominance orientation. Drawing on Duckitt’s dual-process motivational model, in Study 2 (N = 722) we proposed that mindfulness would be positively related with support for progressive taxation through the mediation of lower competitive-jungle beliefs, and then lower social dominance orientation. Instead, we did not expect to find mediation of the link between mindfulness and support for progressive taxation through dangerous-world beliefs and right-wing authoritarianism. These studies inform about the motivational pathways through which mindfulness relates with tax evasion intentions and support for progressive taxation.
Collapse
Affiliation(s)
- Valeria De Cristofaro
- Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy
- * E-mail:
| | - Mauro Giacomantonio
- Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy
| | - Valerio Pellegrini
- Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy
| | - Marco Salvati
- Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy
| | - Luigi Leone
- Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
17
|
Marinello S, Leider J, Powell LM. Employment impacts of the San Francisco sugar-sweetened beverage tax 2 years after implementation. PLoS One 2021; 16:e0252094. [PMID: 34077430 PMCID: PMC8171954 DOI: 10.1371/journal.pone.0252094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/09/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Sugar-sweetened beverage (SSB) taxes have been implemented worldwide to raise revenue and reduce consumption of SSBs, which is associated with health harms. Empirical evaluations have found that these taxes are successful at reducing demand for SSBs; however, SSB taxes face opposition, in part because of claims that they will lead to substantial job losses. The purpose of this study is to examine the impact of the San Francisco SSB tax, implemented on January 1st, 2018, on employment. Methods Monthly employment counts were obtained from the Bureau of Labor Statistics from January 2013 (5-years pre-tax) through December 2019 (2-years post-tax) for the overall economy, private sector, supermarkets and other grocery stores, convenience stores, limited-service restaurants, and beverage manufacturing. A synthetic control analysis was conducted for each employment outcome. The synthetic controls (i.e., estimated counterfactuals) were generated from a pool of urban control counties using pre-tax labor market-related characteristics. Results The synthetic controls had similar labor market-related characteristics and employment outcomes to those in San Francisco in the pre-tax period. Up to 2 years post-tax, differences in employment between San Francisco and the synthetic controls were small and not “statistically significant” based on placebo tests for all employment outcomes. Conclusions Up to two years post-tax, we do not find evidence that the San Francisco SSB tax negatively impacted net employment, employment in the private sector, or employment in specific SSB-related industries.
Collapse
Affiliation(s)
- Samantha Marinello
- Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, Illinois, United States of America
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, Illinois, United States of America
- * E-mail:
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Lisa M. Powell
- Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, Illinois, United States of America
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, Illinois, United States of America
| |
Collapse
|
18
|
Bleich SN, Dunn CG, Soto MJ, Yan J, Gibson LA, Lawman HG, Mitra N, Lowery CM, Peterhans A, Hua SV, Roberto CA. Association of a Sweetened Beverage Tax With Purchases of Beverages and High-Sugar Foods at Independent Stores in Philadelphia. JAMA Netw Open 2021; 4:e2113527. [PMID: 34129022 PMCID: PMC8207239 DOI: 10.1001/jamanetworkopen.2021.13527] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
IMPORTANCE The relationship between a sweetened beverage tax and changes in the prices and purchases of beverages and high-sugar food is understudied in the long term and in small independent food retail stores where sugar-sweetened beverages are among the most commonly purchased items. OBJECTIVE To examine whether a 1.5 cent-per-fluid-ounce excise tax on sugar- and artificially sweetened beverages Philadelphia, Pennsylvania, was associated with sustained changes in beverage prices and purchases, as well as calories purchased from beverages and high-sugar foods, over 2 years at small independent stores. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used a difference-in-differences approach to compare changes in beverage prices and purchases of beverages and high-sugar foods (candy, sweet snacks) at independent stores in Philadelphia and Baltimore, Maryland (a nontaxed control) before and 2 years after tax implementation, which occurred on January 1, 2017. Price comparisons were also made to independent stores in Philadelphia's neighboring counties. MAIN OUTCOMES AND MEASURES Changes in mean price (measured in cents per fluid ounce) of taxed and nontaxed beverages, mean fluid ounces purchased of taxed and nontaxed beverages, and mean total calories purchased from beverages and high-sugar foods. RESULTS Compared with Baltimore independent stores, taxed beverage prices in Philadelphia increased 2.06 cents per fluid ounce (95% CI, 1.75 to 2.38 cents per fluid ounce; P < .001), with 137% of the tax passed through to prices 2 years after tax implementation, while nontaxed beverage prices had no statistically significant change. A total of 116 independent stores and 4738 customer purchases (1950 [41.2%] women; 4351 [91.8%] age 18 years or older; 1006 [21.2%] White customers, 3185 [67.2%] Black customers) at independent stores were assessed for price and purchase comparisons. Purchases of taxed beverages declined by 6.1 fl oz (95% CI, -9.9 to -2.4 fl oz; P < .001), corresponding to a 42% decline in Philadelphia compared with Baltimore; there were no significant changes in purchases of nontaxed beverages. Although there was no significant moderation by neighborhood income or customer education level, exploratory stratified analyses revealed that declines in taxed beverage purchases were larger among customers shopping in low-income neighborhoods (-7.1 fl oz; 95% CI, -13.0 to -1.1 fl oz; P = .001) and individuals with lower education levels (-6.9 fl oz; 95% CI, -12.5 to -1.3 fl oz; P = .001). CONCLUSIONS AND RELEVANCE This cross-sectional study found that a tax on sweetened beverages was associated with increases in price and decreases in purchasing. Beverage excise taxes may be an effective policy to sustainably decrease purchases of sweetened drinks and calories from sugar in independent stores, with large reductions in lower-income areas and among customers with lower levels of education.
Collapse
Affiliation(s)
- Sara N. Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Caroline G. Dunn
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Mark J. Soto
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jiali Yan
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Laura A. Gibson
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Hannah G. Lawman
- Division of Chronic Disease Prevention, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Caitlin M. Lowery
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ana Peterhans
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Sophia V. Hua
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Christina A. Roberto
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
| |
Collapse
|
19
|
Ngo AP, Wang X, Slater S, Chriqui JF, Chaloupka FJ, Yang L, Smith L, Li Q, Shang C. Alcohol excise taxes as a percentage of retail alcohol prices in 26 OECD countries. Drug Alcohol Depend 2021; 219:108415. [PMID: 33307302 PMCID: PMC7856250 DOI: 10.1016/j.drugalcdep.2020.108415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Many countries have implemented alcohol excise taxes. However, measures of excise taxes as a percentage of alcohol prices have not been systematically studied. METHODS Data on the retail prices of alcoholic beverages sold in stores and excise taxes in 26 countries during 2003-2018 was from the Economist Intelligence Unit price city data and the Organization for Economic Co-operation and Development (OECD) tax database. The percentages of excise taxes in off-premise retail prices were derived as the ratio of taxes to prices at different price levels. Changes of excise taxes over time were assessed using negative binominal regressions. RESULTS The percentage of excise taxes in average off-premise alcohol prices was from 5 % in Luxembourg to 59 % in Iceland for beer, and from 0 % in France to 26 % in Iceland for wine. Excise taxes accounted for 5% of discount liquor prices in Czech Republic to 41 % in Sweden for Cognac, for 19 % in the United States (US) to 67 % in Sweden for Gin, for 13 % in the US to 63 % in Australia for Scotch Whisky six years old, and for 6 % in Iceland to 76 % in Sweden for Liqueur Cointreau. There were no significant changes in the percentage of excise taxes in alcohol prices over time in most countries except for Nordic countries. While wine had the lowest excise taxes, liquors had the highest tax burden. CONCLUSION Tax burden on alcoholic beverages is low in OECD countries, indicating ample room for increasing alcohol excise taxes, particularly for beer and wine in those countries.
Collapse
Affiliation(s)
- Anh P Ngo
- Institute for Health Research and Policy, The University of Illinois at Chicago, Chicago, Illinois, USA
| | - Xuening Wang
- University of Illinois at Chicago, Chicago, IL, USA
| | | | - Jamie F Chriqui
- Institute for Health Research and Policy, The University of Illinois at Chicago, Chicago, Illinois, USA
| | - Frank J Chaloupka
- Institute for Health Research and Policy, The University of Illinois at Chicago, Chicago, Illinois, USA
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Canada; Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Qing Li
- Center for Behavioral Epidemiology and Community Health, School of Public Health, San Diego State University, San Diego, CA, USA
| | - Ce Shang
- The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| |
Collapse
|
20
|
Nargis N, Stoklosa M, Shang C, Drope J. Price, Income, and Affordability as the Determinants of Tobacco Consumption: A Practitioner's Guide to Tobacco Taxation. Nicotine Tob Res 2021; 23:40-47. [PMID: 32697827 PMCID: PMC7789936 DOI: 10.1093/ntr/ntaa134] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 07/16/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Tobacco product prices and consumers' income are the two major economic determinants of tobacco demand. The affordability of tobacco products is dependent on the price of tobacco products relative to consumer income. Increase in tobacco tax is expected to lead to higher price, lower affordability, and reduced consumption. Price elasticity and affordability elasticity are used in analyzing the effect of tobacco tax increases on tobacco consumption and public health. The availability of both parameters raises the question of which one to apply in policy discussions. AIMS AND METHODS Using global data on cigarette consumption, price, income, and tobacco control measures for 169 countries over 2007-2016, this study estimated the price elasticity and affordability elasticity of cigarette consumption by country income classification using country-specific fixed effects model for panel data. RESULTS The estimates show that the restriction of equal strength of the effects of price and income changes on tobacco consumption maintained in affordability elasticity estimation is valid for low- and middle-income countries, while it is rejected for high-income countries. CONCLUSIONS Affordability elasticity may prove to be a useful parameter to explain and predict the sensitivity of consumers to tobacco tax and price policy changes under conditions of robust economic growth, which are more likely to be observed in countries with initial low- or middle-income setting. It can provide a reasonable benchmark for tobacco tax and price increase necessary to effectively reduce affordability and consumption of tobacco, which can form a basis for building systematic tax and price increases into the tobacco tax policy mechanism. IMPLICATIONS Price elasticity measures the sensitivity of consumers to changes in real prices, holding real income constant. Affordability elasticity measures the sensitivity of consumers to price changes adjusted for inflation and income changes. Existing scientific literature on tobacco demand abounds in both price and affordability elasticity estimates, without providing a clear explanation of the theoretical and policy implications of using one parameter over the other. By estimating and comparing price and affordability elasticities for high-income and low-and-middle-income countries separately, this article offers a guide to the practitioners in tobacco taxation for evaluating the effectiveness of tax-induced price increases on tobacco consumption.
Collapse
Affiliation(s)
- Nigar Nargis
- Economic and Health Policy Research, American Cancer Society, Inc., Atlanta, GA
| | - Michal Stoklosa
- Economic and Health Policy Research, American Cancer Society, Inc., Atlanta, GA
| | - Ce Shang
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Jeffrey Drope
- Economic and Health Policy Research, American Cancer Society, Inc., Atlanta, GA
| |
Collapse
|
21
|
Pereda P, Garcia CP. Price impact of taxes on sugary drinks in Brazil. Econ Hum Biol 2020; 39:100898. [PMID: 32622931 DOI: 10.1016/j.ehb.2020.100898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 04/16/2020] [Accepted: 06/11/2020] [Indexed: 06/11/2023]
Abstract
Sugary drink consumption is an important contributor to the current global epidemic of obesity. In recent years, 50 countries or jurisdictions have implemented taxes on sugary drinks as an instrument to discourage consumption. Against the tide, Brazil reduced taxes on these beverages in 2017 and 2018. However, a recent debate - raised by the federal government - has started over taxation of sugary and alcoholic beverages (sin taxes). The effectiveness of this policy will depend on how the taxes are transferred to prices. In this sense, this paper we aim to quantify the impacts of the tax reduction on prices of sugary drinks in Brazil, and therefore to contribute to the debate by calculating the pass-through of taxes to prices of these products in the Brazilian context. We analyze the Brazilian market using a panel data of products, by brand, collected by Euromonitor from 2013 to 2018. Our results suggest that the transfer of taxes to prices depends on the firm size and the type of product, with pass-through rates ranging from 15% to 124%.
Collapse
|
22
|
Abstract
IMPORTANCE Health taxes are policy tools used to reduce harmful consumption of products and raise tax revenue, and they may also be associated with signaling (ie, informational and educational) factors that enhance their impact. OBJECTIVES To examine changes in prices and volume sold of sweetened beverages following the implementation and repeal of the Cook County, Illinois, Sweetened Beverage Tax (SBT) compared with the comparison site of St Louis County and city, Missouri, which did not impose a tax. DESIGN, SETTING, AND PARTICIPANTS This study used interrupted time series analyses to assess changes in price and volume sold of taxed (based on beverage type and sweetener status) and untaxed beverages in Cook County compared with St Louis following the implementation of the SBT on August 2, 2017, and its repeal effective December 1, 2017. Statistical analysis was performed from January to June 2020. EXPOSURES Implementation and repeal of the Cook County SBT. MAIN OUTCOMES AND MEASURES Changes in taxed and untaxed beverage prices and volume sold. Nielsen food store scanner data were obtained for weekly volume and dollar amount sold of nonalcoholic beverage universal product codes (UPCs) for each site in supermarkets and mass merchandise, grocery, drug, convenience, and dollar stores. RESULTS The analytic samples included 16 510 UPCs for volume and 2141 UPCs (balanced sample) for prices for 122 pretax weeks, 16 tax weeks, and 35 postrepeal weeks. Compared with St Louis, posttax implementation in Cook County resulted in a level increase in taxed beverage prices of 1.13 cents per fluid ounce (95% CI, 1.01 to 1.25 cents per fluid ounce), representing a slight overshifting, followed by a posttax repeal level decrease of -1.19 cents per fluid ounce (95% CI, -1.33 to -1.04 cents per fluid ounce), with no resulting change pretax to posttax repeal. Volume sold of taxed beverages in Cook County compared with St Louis exhibited a posttax implementation level decrease of 25.7% (β = -0.297; 95% CI, -0.415 to -0.179) and a posttax repeal level increase of 30.5% (β = 0.266, 95% CI, 0.124 to 0.408), with no net change in volume sold from pretax to 8 months after repeal. CONCLUSIONS AND RELEVANCE This study using interrupted time series analysis found no net change in volume sold of taxed beverages following the implementation and repeal of the Cook County SBT, suggesting the tax had no signaling association. Repeals of such taxes may fully reverse their associations with reduced demand and harms associated with sweetened beverage intake.
Collapse
Affiliation(s)
- Lisa M. Powell
- Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago
- Institute for Health Research and Policy, University of Illinois Chicago
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois Chicago
| |
Collapse
|
23
|
Phulkerd S, Thongcharoenchupong N, Chamratrithirong A, Soottipong Gray R, Prasertsom P. Changes in Population-Level Consumption of Taxed and Non-Taxed Sugar-Sweetened Beverages (SSB) after Implementation of SSB Excise Tax in Thailand: A Prospective Cohort Study. Nutrients 2020; 12:nu12113294. [PMID: 33121147 PMCID: PMC7692763 DOI: 10.3390/nu12113294] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 10/21/2020] [Accepted: 10/23/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Thailand has implemented a sugar-sweetened beverage (SSB) excise tax since September 2017, but questions remain about changes in individual-level SSB consumption after tax implementation. This study aimed to analyze the change in taxed and non-taxed SSB consumption in the Thai population. Method: This cohort study was carried out in 2018 and 2019. A total of 5594 persons who participated in both years were included in the analysis. Descriptive and t-test analyses were carried out in order to identify the significance of the difference between taxed and non-taxed SSB consumption in 2018 and 2019. Results: A lower mean ratio of average taxed SSBs consumed to average non-taxed SSBs consumed was found to be statistically significant (p = 0.001). That is, the decline in taxed SSB consumption is significantly greater than that of the non-taxed consumption. The greater reduction in taxed SSB consumption than the non-taxed SSB consumption was found to be significant among males, older persons, the lower-income population, and the unemployed. Conclusions: Overall, the current SSB tax has the capacity to successfully discourage consumption of SSBs with high sugar level. The decline in SSB consumption is, however, not found across all socioeconomic groups. Thresholds for SSB-tiered tax structure may have to be reviewed.
Collapse
Affiliation(s)
- Sirinya Phulkerd
- Institute for Population and Social Research, Mahidol University, Nakhon Pathom 73170, Thailand; (N.T.); (A.C.); (R.S.G.)
- Correspondence:
| | - Natjera Thongcharoenchupong
- Institute for Population and Social Research, Mahidol University, Nakhon Pathom 73170, Thailand; (N.T.); (A.C.); (R.S.G.)
| | - Aphichat Chamratrithirong
- Institute for Population and Social Research, Mahidol University, Nakhon Pathom 73170, Thailand; (N.T.); (A.C.); (R.S.G.)
| | - Rossarin Soottipong Gray
- Institute for Population and Social Research, Mahidol University, Nakhon Pathom 73170, Thailand; (N.T.); (A.C.); (R.S.G.)
| | - Piyada Prasertsom
- Bureau of Dental Health, Department of Health, Ministry of Public Health, Nonthaburi 11000, Thailand;
| |
Collapse
|
24
|
Aljuaid SO, Alshammari SA, Almarshad FA, Almutairi KS, Aljumayi AS, AlKhashan HI, Suliankatchi RA. Taxation and tobacco plain packaging effect on Saudi smokers quitting intentions in Riyadh city, Saudi Arabia. Saudi Med J 2020; 41:1121-1129. [PMID: 33026054 PMCID: PMC7841524 DOI: 10.15537/smj.2020.10.25390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The current research aims to study the impact of raising tobacco tax and implementation of plain packaging on male smokers' quitting intentions in Saudi Arabia. METHODS The study adopts a quantitative approach where close-ended questionnaires are distributed among 1,015 male participants from different regions of Riyadh city, Saudi Arabia. Bivariate analysis and logistic regression analysis are conducted using SPSS software to analyze the collected primary data. RESULTS The study found a significant association of taxation and plain packaging on the quitting intentions of smokers. On taxation, while a considerable number of participants (46.5%) stated that they would not quit smoking if the cigarette prices increased, participants who were planning to give up smoking said it would strengthen their intention (p less than 0.001). In addition, logistic regression was performed to identify the independent predictors of quitting intention. Participants who did not want to apply the concept of plain packaging to Saudi Arabia were more likely to have quitting intention (odds ratio: 2.30 [1.61-3.28]) in comparison to those who wanted to apply the concept. CONCLUSION Although the current price of cigarette packs reported to be very high by the participants, imposing a new higher tax may motivate smokers who had plans to quit in the near future. Plain packaging seems to be an effective new strategy in addition to tobacco taxation in Saudi Arabia, yet, more time and further research are required to assess the effectiveness of the strategy.
Collapse
Affiliation(s)
- Sultan O Aljuaid
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
| | | | | | | | | | | | | |
Collapse
|
25
|
Law C, Cornelsen L, Adams J, Penney T, Rutter H, White M, Smith R. An analysis of the stock market reaction to the announcements of the UK Soft Drinks Industry Levy. Econ Hum Biol 2020; 38:100834. [PMID: 32081676 PMCID: PMC7397522 DOI: 10.1016/j.ehb.2019.100834] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 12/04/2019] [Accepted: 12/06/2019] [Indexed: 06/10/2023]
Abstract
On 16th March 2016, the government of the United Kingdom announced the Soft Drinks Industry Levy (SDIL), under which UK soft-drink manufacturers were to be taxed according to the volume of products with added sugar they produced or imported. We use 'event study' methodology to assess the likely financial effect of the SDIL on parts of the soft drinks industry, using stock returns of four UK-operating soft-drink firms listed on the London Stock Exchange. We found that three of the four firms experienced negative abnormal stock returns on the day of announcement. A cross-sectional analysis revealed that the cumulative abnormal returns of soft drink stocks were not significantly less than that of other food and drinks-related stocks beyond the day of the SDIL announcement. Our findings suggest that the SDIL announcement was initially perceived as detrimental news by the market but negative stock returns were short-lived, indicating a lack of major concerns for industry. There was limited evidence of a negative stock market reaction to the two subsequent announcements: release of draft legislation on 5th December 2016, and confirmation of the tax rates on 8th March 2017.
Collapse
Affiliation(s)
- Cherry Law
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, United Kingdom.
| | - Laura Cornelsen
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Jean Adams
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, United Kingdom
| | - Tarra Penney
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, United Kingdom
| | - Harry Rutter
- Department of Social & Policy Sciences, University of Bath, United Kingdom
| | - Martin White
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, United Kingdom
| | - Richard Smith
- College of Medicine & Health, University of Exeter, United Kingdom
| |
Collapse
|
26
|
Shang C, Ngo A, Chaloupka FJ. The pass-through of alcohol excise taxes to prices in OECD countries. Eur J Health Econ 2020; 21:855-867. [PMID: 32236765 PMCID: PMC9996670 DOI: 10.1007/s10198-020-01177-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 03/10/2020] [Indexed: 06/11/2023]
Abstract
Tax pass-through rates to prices measure how much prices increase when taxes are increased by one unit, which will in turn determine the effectiveness of taxation policies in reducing substance use. Using longitudinal data of alcohol prices and excise taxes from 27 Organization for Economic Cooperation and Development (OECD) countries from 2003 to 2016, we estimate the tax pass-through rates to prices for a variety of alcoholic beverages-beer (1.24; 95% CIs: [0.67, 1.81]), wine (2.4; 95% CIs: [1.7, 3.11]), Cognac (1.71; 95% CIs: [1.07, 2.35]), Gin (0.85; 95% CIs: [0.34, 1.35]), Scotch whisky (1.14; 95% CIs: [0.52, 1.75]), and Liqueur Cointreau (1.98; 95% CIs: [1.21, 2.76]). While excise taxes on wine, Cognac, and Liqueur Cointreau are over-shifted to prices, taxes on Gin are exact- or under-shifted. Excise taxes on beer and Scotch whisky are likely over-shifted to prices, but the tax pass-through rates for these beverages are not significantly different from 1 and we cannot completely rule out exact pass-through of taxes to prices. The tax pass-through to prices for most beverage types is also higher for higher-priced products. Dynamic model further shows a lagged impact of wine and beer taxes on prices, indicating pricing strategies that may target lower-priced beer and wine.
Collapse
Affiliation(s)
- Ce Shang
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
| | - Anh Ngo
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Frank J Chaloupka
- Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, USA
| |
Collapse
|
27
|
Kotsopoulos N, Connolly MP, Dort T, Kavaliunas A. The fiscal consequences of public health investments in disease-modifying therapies for the treatment of multiple sclerosis in Sweden. J Med Econ 2020; 23:831-837. [PMID: 32400258 DOI: 10.1080/13696998.2020.1757457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background and aims: The economic consequences of multiple sclerosis (MS) are broader than those observed within the health system. The progressive nature suggests that people will not be able to live a normal productive life and will gradually require public benefits to maintain living standards. This study investigates the public economic impact of MS and how investments in disease-modifying therapies (DMTs) influence the lifetime costs to government attributed to changes in lifetime tax revenue and disability benefits based on improved health status linked to delayed disease progression.Methods: Disease progression rates from previous MS Markov cohort models were applied to interferon beta-1a, peginterferon beta-1a, dimethyl fumarate, and natalizumab using a public economic framework. The established relationship between expanded disability status scale and work-force participation, annual earnings, and disability rates for each DMT were applied. Subsequently, we assessed the effect of DMTs on discounted governmental costs consisting of health service costs, social insurance and disability costs, and changes in lifetime tax revenues.Results: Fiscal benefits attributed to informal care and community services savings for interferon beta-1a, peginterferon beta-1a, dimethyl fumarate, and natalizumab were SEK340,387, SEK486,837, SEK257,330, and SEK958,852 compared to placebo, respectively. Tax revenue gains linked to changes in lifetime productivity for interferon beta-1a, peginterferon beta-1a, dimethyl fumarate, and natalizumab were estimated to be SEK27,474, SEK39,659, SEK21,661, and SEK75,809, with combined fiscal benefits of cost savings and tax revenue increases of SEK410,039, SEK596,592, SEK326,939, and SEK1,208,023, respectively.Conclusion: The analysis described here illustrates the broader public economic benefits for government attributed to changes in disease status. The lifetime social insurance transfer costs were highest in non-treated patients, and lower social insurance costs were demonstrated with DMTs. These findings suggest that focusing cost-effectiveness analysis only on health costs will likely underestimate the value of DMTs.
Collapse
Affiliation(s)
- Nikolaos Kotsopoulos
- Health Economics, Global Market Access Solutions Sarl, St-Prex, Switzerland
- Department of Economics, University of Athens, Athens, Greece
| | - Mark P Connolly
- Health Economics, Global Market Access Solutions Sarl, St-Prex, Switzerland
- Unit of Pharmacoepidemiology & Pharmacoeconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Thibaut Dort
- Global Value & Access, Biogen International GmbH, Baar, Switzerland
| | - Andrius Kavaliunas
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
28
|
Kao KE, Jones AC, Ohinmaa A, Paulden M. The health and financial impacts of a sugary drink tax across different income groups in Canada. Econ Hum Biol 2020; 38:100869. [PMID: 32442926 DOI: 10.1016/j.ehb.2020.100869] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 03/16/2020] [Accepted: 03/20/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Overconsumption of sugar-sweetened beverages (SSBs) contributes to childhood and adult obesity and numerous related diseases, including heart disease, strokes, cancers, and type 2 diabetes. It also increases healthcare costs. Sugary drink taxes have been implemented in several countries to curb sugar intake. However, there is a concern that sugary drink taxes are regressive. This study assessed the health and financial impacts of a simulated sugary drink tax across different income groups in Canada. METHODS A proportional multi-state life table-based Markov model simulated the 2016 Canadian population by income quintile. The model applied a 20 % tax on sugary drinks and determined the effects on type 2 diabetes and BMI-related diseases compared to no intervention. The income-specific parameters modelled included: population demographics; cross- and own-price elasticities; mean BMI; sugary drink consumption; mortality; and disease epidemiology. RESULTS A 20 % sugary drink tax was estimated to reduce the consumption of sugary drinks by an average of around 15 %, with a greater reduction in the lowest income quintile. The estimated mean reduction in BMI ranged from 0.21 to 0.33, dependent upon sex and income quintile; these reductions were greater among the lower income quintiles for both females and males. The 20 % sugary drink tax was estimated to avert approximately 690,000 DALYs over a lifetime among the 2016 Canadian adult population; estimated DALYs averted were approximately 156,000, 140,000, 137,000, 134,000, and 125,000 for the lowest through to the highest income quintile, respectively. Lifetime health care savings were estimated to be $2.27bn, $2.16bn, $2.17bn, $2.12bn, and $1.98bn for the lowest through to the highest income quintile, respectively. The estimated annual tax burden for the 2016 Canadian population was $1.4bn. The average absolute tax burden was estimated to be $39.00 to $44.30 per person, with the middle-income quintile bearing the heaviest absolute tax burden. The lowest income quintile would pay the highest proportion of income in tax, implying that the tax is regressive. CONCLUSIONS Low-income Canadians would gain the most health benefit from a sugary drinks tax. However, the lowest income quintile would also pay the largest proportion of income in tax. A tax on sugary drinks is therefore financially regressive but forecast to reduce health disparities across Canada.
Collapse
Affiliation(s)
- Kai-Erh Kao
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, Alberta, T6G 1C9, Canada
| | - Amanda C Jones
- Department of Public Health, University of Otago, PO Box 7343, Newtown, Wellington 6242, New Zealand
| | - Arto Ohinmaa
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, Alberta, T6G 1C9, Canada
| | - Mike Paulden
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, Alberta, T6G 1C9, Canada.
| |
Collapse
|
29
|
|
30
|
Falbe J, Lee MM, Kaplan S, Rojas NA, Ortega Hinojosa AM, Madsen KA. Higher Sugar-Sweetened Beverage Retail Prices After Excise Taxes in Oakland and San Francisco. Am J Public Health 2020; 110:1017-1023. [PMID: 32437271 PMCID: PMC7287565 DOI: 10.2105/ajph.2020.305602] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2020] [Indexed: 11/04/2022]
Abstract
Objectives. To examine how much sugar-sweetened beverage (SSB) excise taxes increased SSB retail prices in Oakland and San Francisco, California.Methods. We collected pretax (April-May 2017) and posttax (April-May 2018) retail prices of SSBs and non-SSBs from 155 stores in Oakland, San Francisco, and comparison cities. We analyzed data using difference-in-differences high-dimensional fixed-effects regressions, weighted by regional beverage sales.Results. Across all beverage sizes, the weighted average price of SSBs increased by 0.92 cents per ounce (95% confidence interval [CI] = 0.28, 1.56) in Oakland and 1.00 cents per ounce (95% CI = 0.35, 1.65) in San Francisco, compared with prices in untaxed cities. The tax did not significantly alter prices of water, 100% juice, or milk of any size examined. Diet soda only, among non-SSBs, exhibited a higher price increase for some sizes in taxed cities.Conclusions. Within 4 to 10 months of implementation, Oakland's and San Francisco's SSB excise taxes significantly increased SSB retail prices by approximately the amount of the taxes, a key mechanism for reducing consumption.
Collapse
Affiliation(s)
- Jennifer Falbe
- Jennifer Falbe is with the Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis. At the time of the study, Matthew M. Lee was with the divisions of Community Health Sciences and Epidemiology, University of California, Berkeley School of Public Health. Nadia A. Rojas and Kristine A. Madsen were with the Division of Community Health Sciences, University of California, Berkeley School of Public Health. Scott Kaplan is with the Department of Agricultural and Resource Economics, University of California, Berkeley. Alberto M. Ortega Hinojosa is with the Health Division, IMPAQ International, Oakland, CA
| | - Matthew M Lee
- Jennifer Falbe is with the Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis. At the time of the study, Matthew M. Lee was with the divisions of Community Health Sciences and Epidemiology, University of California, Berkeley School of Public Health. Nadia A. Rojas and Kristine A. Madsen were with the Division of Community Health Sciences, University of California, Berkeley School of Public Health. Scott Kaplan is with the Department of Agricultural and Resource Economics, University of California, Berkeley. Alberto M. Ortega Hinojosa is with the Health Division, IMPAQ International, Oakland, CA
| | - Scott Kaplan
- Jennifer Falbe is with the Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis. At the time of the study, Matthew M. Lee was with the divisions of Community Health Sciences and Epidemiology, University of California, Berkeley School of Public Health. Nadia A. Rojas and Kristine A. Madsen were with the Division of Community Health Sciences, University of California, Berkeley School of Public Health. Scott Kaplan is with the Department of Agricultural and Resource Economics, University of California, Berkeley. Alberto M. Ortega Hinojosa is with the Health Division, IMPAQ International, Oakland, CA
| | - Nadia A Rojas
- Jennifer Falbe is with the Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis. At the time of the study, Matthew M. Lee was with the divisions of Community Health Sciences and Epidemiology, University of California, Berkeley School of Public Health. Nadia A. Rojas and Kristine A. Madsen were with the Division of Community Health Sciences, University of California, Berkeley School of Public Health. Scott Kaplan is with the Department of Agricultural and Resource Economics, University of California, Berkeley. Alberto M. Ortega Hinojosa is with the Health Division, IMPAQ International, Oakland, CA
| | - Alberto M Ortega Hinojosa
- Jennifer Falbe is with the Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis. At the time of the study, Matthew M. Lee was with the divisions of Community Health Sciences and Epidemiology, University of California, Berkeley School of Public Health. Nadia A. Rojas and Kristine A. Madsen were with the Division of Community Health Sciences, University of California, Berkeley School of Public Health. Scott Kaplan is with the Department of Agricultural and Resource Economics, University of California, Berkeley. Alberto M. Ortega Hinojosa is with the Health Division, IMPAQ International, Oakland, CA
| | - Kristine A Madsen
- Jennifer Falbe is with the Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis. At the time of the study, Matthew M. Lee was with the divisions of Community Health Sciences and Epidemiology, University of California, Berkeley School of Public Health. Nadia A. Rojas and Kristine A. Madsen were with the Division of Community Health Sciences, University of California, Berkeley School of Public Health. Scott Kaplan is with the Department of Agricultural and Resource Economics, University of California, Berkeley. Alberto M. Ortega Hinojosa is with the Health Division, IMPAQ International, Oakland, CA
| |
Collapse
|
31
|
Berlin J. Buying Time: Comptroller Delays Medical Billing Tax Until October 2021. Tex Med 2020; 116:30-32. [PMID: 32645180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Comptroller delays medical billing tax until October 2021, giving TMA a chance to work out a legislative fix.
Collapse
|
32
|
Apollonio DE, Glantz SA. Tobacco Industry Promotions and Pricing After Tax Increases: An Analysis of Internal Industry Documents. Nicotine Tob Res 2020; 22:967-974. [PMID: 31058282 PMCID: PMC7249914 DOI: 10.1093/ntr/ntz068] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 04/25/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND Increasing tobacco taxes, and through them, prices, is an effective public health strategy to decrease tobacco use. The tobacco industry has developed multiple promotional strategies to undercut these effects; this study assessed promotions directed to wholesalers and retailers and manufacturer price changes that blunt the effects of tax and price increases. METHODS We reviewed tobacco industry documents and contemporaneous research literature dated 1987 to 2016 to identify the nature, extent, and effectiveness of tobacco industry promotions and price changes used after state-level tobacco tax increases. RESULTS Tobacco companies have created promotions to reduce the effectiveness of tobacco tax increases by encouraging established users to purchase tobacco in lower-tax jurisdictions and sometimes lowering manufacturer pricing to "undershift" smaller tax increases, so that tobacco prices increased by less than the amount of the tax. CONCLUSIONS Policymakers should address industry efforts to undercut an effective public health intervention through regulating minimum prices, limiting tobacco industry promotions, and by enacting tax increases that are large, immediate, and result in price increases. IMPLICATIONS Tobacco companies view excise tax increases on tobacco products as a critical business threat. To keep users from quitting or reducing tobacco use in response to tax increases, they have shifted manufacturer pricing and developed specific promotions that encourage customers to shop for lower-taxed products. Health authorities should address tobacco industry efforts to undercut the effects of taxes by regulating prices and promotions and passing large and immediate tax increases.
Collapse
Affiliation(s)
- Dorie E Apollonio
- Department of Clinical Pharmacy, University of California, San Francisco, CA
| | - Stanton A Glantz
- Department of Medicine, University of California, San Francisco, CA
| |
Collapse
|
33
|
Pope DA, Poe L, Stein JS, Kaplan BA, DeHart WB, Mellis AM, Heckman BW, Epstein LH, Chaloupka FJ, Bickel WK. The Experimental Tobacco Marketplace: Demand and Substitutability as a Function of Cigarette Taxes and e-Liquid Subsidies. Nicotine Tob Res 2020; 22:782-790. [PMID: 31350894 PMCID: PMC7171289 DOI: 10.1093/ntr/ntz116] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 07/23/2019] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The experimental tobacco marketplace (ETM) approximates real-world situations by estimating the effects of several, concurrently available products and policies on budgeted purchasing. Although the effects of increasing cigarette price on potentially less harmful substitutability are well documented, the effects of other, nuanced pricing policies remain speculative. This study used the ETM as a tool to assess the effects of two pricing policies, conventional cigarette taxation and e-liquid subsidization, on demand and substitutability. METHODS During sampling periods, participants were provided 2-day samples of 24 mg/mL e-liquid, after which ETM purchase sessions occurred. Across two ETM sessions, conventional cigarettes were taxed or e-liquid was subsidized in combination with increasing cigarette price. The other four available products were always price constant and not taxed or subsidized. RESULTS E-liquid functioned as a substitute for conventional cigarettes across all conditions. Increasing cigarette taxation and e-liquid subsidization increased the number of participants for which e-liquid functioned as a substitute. Cigarette taxation decreased cigarette demand, by decreasing demand intensity, and marginally increased the initial intensity of e-liquid substitution, but did not affect the functions' slopes (substitutability). E-liquid subsidization resulted in large increases in the initial intensity of e-liquid substitution, but did not affect e-liquid substitutability nor cigarette demand. IMPLICATIONS 24 mg/mL e-cigarette e-liquid was the only product to significantly substitute for cigarettes in at least one condition throughout the experiment; it functioned as a significant substitute throughout all four tax and all four subsidy conditions. Increasing cigarette taxes decreased cigarette demand through decreases in demand intensity but did not affect e-cigarette substitution. Increasing e-liquid subsidies increased e-liquid initial intensity of substitution but did not affect cigarette demand. CONCLUSIONS This study extended research on the behavioral economics of conventional cigarette demand and e-liquid substitutability in a complex marketplace. The results suggest that the most efficacious method to decrease conventional cigarette purchasing and increase e-liquid purchasing may involve greatly increasing cigarette taxes while also increasing the value of e-liquid through potentially less harmful product subsidization or differential taxation.
Collapse
Affiliation(s)
- Derek A Pope
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, VA
| | - Lindsey Poe
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, VA
| | - Jeffrey S Stein
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, VA
| | - Brent A Kaplan
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, VA
| | - William B DeHart
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, VA
| | - Alexandra M Mellis
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, VA
| | - Bryan W Heckman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Leonard H Epstein
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
| | - Frank J Chaloupka
- Department of Economics, University of Illinois at Chicago, Chicago, IL
| | - Warren K Bickel
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, VA
| |
Collapse
|
34
|
Herbst JL, O'Brien SJ, Chumas EG. Hospital Taxes, Medicaid Supplemental Payments, and State Budgets. J Leg Med 2020; 40:135-170. [PMID: 33137277 DOI: 10.1080/01947648.2020.1822243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 01/10/2020] [Accepted: 02/13/2020] [Indexed: 06/11/2023]
Abstract
The federal Medicaid statute provides states an incentive to tax hospitals (even otherwise tax-exempt ones) as a means of raising revenue and then leverage federal matching funds by returning at least some of the tax back to the hospitals in the form of Medicaid supplemental payments. The potential for supplemental payments is attractive to hospitals, especially those struggling to recoup the costs of treating Medicaid and uninsured patients, and has resulted in political support from hospitals for states to create hospital "taxes" in name only-hospitals and states both end up with more money than they did when they started because of the federal match. When state officials begin to perceive, however, that nonprofit hospitals may be serving private rather than public interests, they are able to use these hospital taxes as a way to incrementally chip away at the historic governmental support provided through tax exemption by redirecting the revenue raised from the hospital tax to general fund purposes rather than Medicaid supplemental payments. This article looks at how states have been using hospital taxes and supplemental payments to balance state budgets and whether this practice is consistent with the Medicaid program objectives that make the taxes politically feasible.
Collapse
|
35
|
Blakely T, Nghiem N, Genc M, Mizdrak A, Cobiac L, Mhurchu CN, Swinburn B, Scarborough P, Cleghorn C. Modelling the health impact of food taxes and subsidies with price elasticities: The case for additional scaling of food consumption using the total food expenditure elasticity. PLoS One 2020; 15:e0230506. [PMID: 32214329 PMCID: PMC7098589 DOI: 10.1371/journal.pone.0230506] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 03/03/2020] [Indexed: 11/24/2022] Open
Abstract
Background Food taxes and subsidies are one intervention to address poor diets. Price elasticity (PE) matrices are commonly used to model the change in food purchasing. Usually a PE matrix is generated in one setting then applied to another setting with differing starting consumptions and prices of foods. This violates econometric assumptions resulting in likely mis-estimation of total food consumption. In this paper we demonstrate this problem, canvass possible options for rescaling all consumption after applying a PE matrix, and illustrate the use of a total food expenditure elasticity (TFEe; the expenditure elasticity for all food combined given the policy-induced change in the total price of food). We use case studies of: NZ$2 per 100g saturated fat (SAFA) tax, NZ$0.4 per 100g sugar tax, and a 20% fruit and vegetable (F&V) subsidy. Methods We estimated changes in food purchasing using a NZ PE matrix applied conventionally, and then with TFEe adjustment. Impacts were quantified for pre- to post-policy changes in total food expenditure and health adjusted life years (HALYs) for the total NZ population alive in 2011 over the rest of their lifetime using a multistate lifetable model. Results Two NZ studies gave TFEe’s of 0.68 and 0.83, with international estimates ranging from 0.46 to 0.90 (except a UK outlier of 0.04). Without TFEe adjustment, total food expenditure decreased with the tax policies and increased with the F&V subsidy–implausible directions of shift given economic theory and the external TFEe estimates. After TFEe adjustment, HALY gains reduced by a third to a half for the two taxes and reversed from an apparent health loss to a health gain for the F&V subsidy. With TFEe adjustment, HALY gains (in 1000’s) were: 1,805 (95% uncertainty interval 1,337 to 2,340) for the SAFA tax; 1,671 (1,220 to 2,269) for the sugar tax; and 953 (453 to 1,308) for the F&V subsidy. Conclusions If PE matrices are applied in settings beyond where they were derived, additional scaling is likely required. We suggest that the TFEe is a useful scalar, but we also encourage other researchers to examine this issue and propose alternative options.
Collapse
Affiliation(s)
- Tony Blakely
- Population Interventions Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand
- * E-mail:
| | - Nhung Nghiem
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Murat Genc
- Department of Economics, University of Otago, Dunedin, New Zealand
| | - Anja Mizdrak
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Linda Cobiac
- Nuffield Department of Population Health, Oxford University, Oxford, United Kingdom
| | - Cliona Ni Mhurchu
- National Institute of Health Innovation, University of Auckland, Auckland, New Zealand
| | - Boyd Swinburn
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Peter Scarborough
- Nuffield Department of Population Health, Oxford University, Oxford, United Kingdom
| | - Christine Cleghorn
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand
| |
Collapse
|
36
|
Ait Bihi Ouali L. Effects of signalling tax evasion on redistribution and voting preferences: Evidence from the Panama Papers. PLoS One 2020; 15:e0229394. [PMID: 32155170 PMCID: PMC7064205 DOI: 10.1371/journal.pone.0229394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 02/05/2020] [Indexed: 11/19/2022] Open
Abstract
This paper provides empirical evidence that individuals substantially revise their stated wealth redistribution preferences after fiscal scandals. The 2016 Panama Papers scandal revealed top-income tax evasion behaviour simultaneously worldwide. The empirical investigation exploits this event as a quasi-natural experiment. I rely on two original datasets, a UK household longitudinal dataset and a survey conducted in 22 European countries. I use a difference-in-differences strategy and find that pro-redistribution statements increased between 2% and 3.3% after the scandal. Responses are heterogeneous and larger for right-wing individuals and low-income individuals. This change in wealth redistribution preferences is likely to have been translated into a slight change in votes. The results suggest an increase in stated voting intentions for the left and a decrease for the right. Complementary estimations reveal that more media coverage and more individuals involved by country increase the magnitude of the response.
Collapse
Affiliation(s)
- Laila Ait Bihi Ouali
- Dept. of Civil and Environmental Engineering, Imperial College London, London, United Kingdom
- * E-mail:
| |
Collapse
|
37
|
Robinson E, Nguyen P, Jiang H, Livingston M, Ananthapavan J, Lal A, Sacks G. Increasing the Price of Alcohol as an Obesity Prevention Measure: The Potential Cost-Effectiveness of Introducing a Uniform Volumetric Tax and a Minimum Floor Price on Alcohol in Australia. Nutrients 2020; 12:E603. [PMID: 32110864 PMCID: PMC7146351 DOI: 10.3390/nu12030603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 11/16/2022] Open
Abstract
The objective of this study was to estimate, from an obesity prevention perspective, the cost-effectiveness of two potential policies that increase the price of alcohol in Australia: a volumetric tax applied to all alcohol (Intervention 1) and a minimum unit floor price (Intervention 2). Estimated changes in alcoholic drink consumption and corresponding changes in energy intake were calculated using the 2011-12 Australian Health Survey data, published price elasticities, and nutrition information. The incremental changes in body mass index (BMI), BMI-related disease outcomes, healthcare costs, and Health Adjusted Life Years (HALYs) were estimated using a validated model. Costs associated with each intervention were estimated for government and industry. Both interventions were estimated to lead to reductions in mean alcohol consumption (Intervention 1: 20.7% (95% Uncertainty Interval (UI): 20.2% to 21.1%); Intervention 2: 9.2% (95% UI: 8.9% to 9.6%); reductions in mean population body weight (Intervention 1: 0.9 kg (95% UI: 0.84 to 0.96); Intervention 2: 0.45 kg (95% UI: 0.42 to 0.48)); HALYs gained (Intervention 1: 566,648 (95% UI: 497,431 to 647,262); Intervention 2: 317,653 (95% UI: 276,334 to 361,573)); and healthcare cost savings (Intervention 1: $5.8 billion (B) (95% UI: $5.1B to $6.6B); Intervention 2: $3.3B (95% UI: $2.9B to $3.7B)). Intervention costs were estimated as $24M for Intervention 1 and $30M for Intervention 2. Both interventions were dominant, resulting in health gains and cost savings. Increasing the price of alcohol is likely to be cost-effective from an obesity prevention perspective in the Australian context, provided consumers substitute alcoholic beverages with low or no kilojoule alternatives.
Collapse
Affiliation(s)
- Ella Robinson
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia; (P.N.); (J.A.); (A.L.); (G.S.)
| | - Phuong Nguyen
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia; (P.N.); (J.A.); (A.L.); (G.S.)
- Deakin Health Economics (DHE), Institute for Health Transformation, Deakin University, Burwood, VIC 3125, Australia
| | - Heng Jiang
- Centre for Alcohol Policy Research (CAPR), School of Psychology and Public Health, La Trobe University, Bundoora, VIC 3086, Australia; (H.J.); (M.L.)
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Carlton VIC 3053, Australia
| | - Michael Livingston
- Centre for Alcohol Policy Research (CAPR), School of Psychology and Public Health, La Trobe University, Bundoora, VIC 3086, Australia; (H.J.); (M.L.)
| | - Jaithri Ananthapavan
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia; (P.N.); (J.A.); (A.L.); (G.S.)
- Deakin Health Economics (DHE), Institute for Health Transformation, Deakin University, Burwood, VIC 3125, Australia
| | - Anita Lal
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia; (P.N.); (J.A.); (A.L.); (G.S.)
- Deakin Health Economics (DHE), Institute for Health Transformation, Deakin University, Burwood, VIC 3125, Australia
| | - Gary Sacks
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia; (P.N.); (J.A.); (A.L.); (G.S.)
| |
Collapse
|
38
|
Leight J, Wilson N. Framing Flexible Spending Accounts: A Large-Scale Field Experiment on Communicating the Return on Medical Savings Accounts. Health Econ 2020; 29:195-208. [PMID: 31766076 DOI: 10.1002/hec.3965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/30/2019] [Accepted: 09/04/2019] [Indexed: 06/10/2023]
Abstract
Tax-preferred health savings devices such as Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) offer employees potentially valuable financial instruments for directing pre-tax earnings to eligible medical expenses. Despite their increasing popularity as an employee benefit, however, there is little causal evidence around individual demand for these accounts. This paper seeks to address this gap in the literature, reporting on a randomized controlled field experiment conducted with over 11,000 U. S federal employees in 2017 in order to evaluate the effectiveness of targeted messages designed to increase FSA contributions. Our results suggest that the provision of basic information about FSAs delivered via an emailed employee newsletter did not affect the likelihood of contribution or the contribution level. The addition of statements about the absolute returns or relative returns offered by the accounts similarly had no significant effects, and these null effects are observed despite relatively high email open rates. We discuss explanations for the null results and the policy implications of findings from what appears to be the first health economics experiment analyzing tax incentives around health care savings.
Collapse
Affiliation(s)
- Jessica Leight
- International Food Policy Research Institute, Washington, DC, USA
| | - Nicholas Wilson
- International Food Policy Research Institute, Washington, DC, USA
- Economics, Reed College, Oregon, USA
| |
Collapse
|
39
|
Affiliation(s)
- Prabhat Jha
- Centre for Global Health Research, Unity Health Toronto, University of Toronto, Toronto, ON M5B 1W8, Canada.
| | | | - Daphne C N Wu
- Centre for Global Health Research, Unity Health Toronto, University of Toronto, Toronto, ON M5B 1W8, Canada
| | - Richard Peto
- Clinical Trial Service Unit, Richard Doll Building, University of Oxford, UK
| |
Collapse
|
40
|
Abstract
In this paper, we analyze a tax on sugar-sweetened beverages (SSB) that was introduced in Catalonia on May 1, 2017. The Bill established the requirement of a 100% pass-through of the tax to the final consumer and two levels of the tax: 0.08 euro/liter for products with 5-less than 8 g of sugar and 0.12 euro/liter for products with 8 g of sugar or more. Previous literature focusing on the impact of SSB taxes finds that pass-though is only complete in the long-term. Our paper provides new evidence that, when the tax increases prices substantially and immediately, the sales response is also significant. In particular, we estimate that the new SSB tax in Catalonia reduced SSB purchases by 7.7%. We document that part of this reduction is substituted by an increase in sales of zero/light drinks (substitution effect). Importantly, the reduction in purchases is stronger in areas with a higher incidence of obesity, in areas with higher household incomes and for products with higher sugar content.
Collapse
Affiliation(s)
- Judit Vall Castelló
- Universitat de Barcelona & Institut d'Economia de Barcelona & CRES-UPF, Spain.
| | - Guillem Lopez Casasnovas
- Department of Economics & Centre for Research in Health and Economics, Universitat Pompeu Fabra, Spain
| |
Collapse
|
41
|
Abstract
A major challenge to achieve health coverage in Nigeria is expansion of health access to the poor, vulnerable and informal sectors, which constitute over 70% of the population of more than 186 million. Evidence from other countries suggests that it is difficult for contributory insurance schemes to achieve universal health coverage in such conditions, especially with such a large informal sector. In fact, Nigeria's national social health insurance program has provided coverage to less than 5% of the population since its implementation in 2005, private voluntary health insurance has shown poor potential to extend coverage, and community-based health insurance has failed to expand access to poor, vulnerable and informal sector populations as well. Decentralization of health insurance to the states has limited potential to expand health insurance coverage for the poor, vulnerable and those in the informal sector. Furthermore, social health insurance in many developed countries has taken many years to achieve universal health coverage. This paper suggests that policy makers should consider adopting a tax-based, noncontributory, universal health-financing system as the primary funding mechanism to accelerate progress toward universal health coverage. Social health insurance and its decentralization to states for formal sector workers should serve as a supplement, while private voluntary health insurance should cover better-off groups. Simultaneously, it is critical to tackle issues of poor governance structures, mismanagement of funds, corruption, and lack of transparency and accountability within regulatory and implementing agencies, to ensure that monies allocated for expanded health insurance coverage are well managed. Although the proposed universal health coverage reform may take some years to achieve, it is more feasible to collect taxes, improve tax administration and expand the tax base than to enforce payment of contributions from nonsalaried workers and those who cannot afford to pay for health insurance or for services out of pocket.
Collapse
|
42
|
Hu X, Wang Y, Huang J, Zheng R. Cigarette Affordability and Cigarette Consumption among Adult and Elderly Chinese Smokers: Evidence from A Longitudinal Study. Int J Environ Res Public Health 2019; 16:E4832. [PMID: 31805685 PMCID: PMC6927005 DOI: 10.3390/ijerph16234832] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 11/23/2019] [Accepted: 11/27/2019] [Indexed: 11/16/2022]
Abstract
China is in the midst of an epidemic of non-communicable diseases (NCDs), which has increasingly accounted for a growing share of disease burden, due in part to China's ongoing rapid socioeconomic changes and population aging. Smoking, the second leading health risk factors associated with NCDs in China, disproportionately affects the old population more than their younger counterparts. Using survey data from the China Health and Retirement Longitudinal Study (CHARLS), this study evaluated the impact of changes in cigarette affordability on smoking behavior among middle-aged and elderly (age 45 and older) smokers. Self-reported cigarette price and disposable income were used to calculate cigarette affordability. Cigarette consumption was measured using the number of cigarettes smoked per day reported by the survey respondents. The correlation between cigarette affordability and cigarette consumption was estimated using generalized estimating equations adjusting for demographics, socioeconomic status, geolocations, and cigarette price tiers, as well as year fixed effects. The estimated overall conditional cigarette affordability elasticity of demand was -0.165, implying a 10% decrease in cigarette affordability would result in a reduction in cigarette consumption by 1.65%. The cigarette affordability responsiveness differs by demographics, socioeconomic status, geolocations, and cigarette price tiers. This study provides evidence that tax/price policies that reduce cigarette affordability could lead to a decrease in cigarette consumption among middle-aged and elderly smokers in China. Smoke-free laws, as well as minimum price regulations, may be needed to compliment excise tax policy to target specific smoking subgroups whose cigarette consumption is less sensitive to changes in cigarette affordability.
Collapse
Affiliation(s)
- Xiao Hu
- School of International Trade and Economics, University of International Business and Economics, Beijing 100029, China; (X.H.); (Y.W.)
| | - Yang Wang
- School of International Trade and Economics, University of International Business and Economics, Beijing 100029, China; (X.H.); (Y.W.)
| | - Jidong Huang
- School of Public Health, Georgia State University, Atlanta, GA 30303, USA;
| | - Rong Zheng
- School of International Trade and Economics, University of International Business and Economics, Beijing 100029, China; (X.H.); (Y.W.)
| |
Collapse
|
43
|
Long MW, Polacsek M, Bruno P, Giles CM, Ward ZJ, Cradock AL, Gortmaker SL. Cost-Effectiveness Analysis and Stakeholder Evaluation of 2 Obesity Prevention Policies in Maine, US. J Nutr Educ Behav 2019; 51:1177-1187. [PMID: 31402290 DOI: 10.1016/j.jneb.2019.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 06/17/2019] [Accepted: 07/07/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate the potential cost-effectiveness of and stakeholder perspectives on a sugar-sweetened beverage (SSB) excise tax and a Supplemental Nutrition Assistance Program (SNAP) policy that would not allow SSB purchases in Maine, US. DESIGN A cost-effectiveness simulation model combined with stakeholder interviews. SETTING Maine, US. PARTICIPANTS Microsimulation of the Maine population in 2015 and interviews with stakeholders (n = 14). Study conducted from 2013 to 2017. MAIN OUTCOME MEASURES Health care cost savings, net costs, and quality-adjusted life-years (QALYs) from 2017 to 2027. Stakeholder positions on policies. Retail SSB cost and implementation cost data were collected. ANALYSIS Childhood Obesity Intervention Cost-Effectiveness Study project microsimulation model with uncertainty analysis to estimate cost-effectiveness. Thematic stakeholder interview coding. RESULTS Over 10 years, the SSB and SNAP policies were projected to reduce health care costs by $78.3 million (95% uncertainty interval [UI], $31.7 million-$185 million) and $15.3 million (95% UI, $8.32 million-$23.9 million), respectively. The SSB and SNAP policies were projected to save 3,560 QALYs (95% UI, 1,447-8,361) and 749 QALYs (95% UI, 415-1,168), respectively. Stakeholders were more supportive of SSB taxes than the SNAP policy because of equity concerns associated with the SNAP policy. CONCLUSIONS AND IMPLICATIONS Cost-effectiveness analysis provided evidence of potential health improvement and cost savings to state-level stakeholders weighing broader implementation considerations.
Collapse
Affiliation(s)
- Michael W Long
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC.
| | - Michele Polacsek
- Department of Public Health, College of Health Professions, University of New England, Portland, ME
| | - Pamela Bruno
- Department of Public Health, College of Health Professions, University of New England, Portland, ME
| | - Catherine M Giles
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Zachary J Ward
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Angie L Cradock
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Steven L Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| |
Collapse
|
44
|
Chavez G, Minkler M, McDaniel PA, Estrada J, Thayer R, Falbe J. Retailers' perspectives on selling tobacco in a low-income San Francisco neighbourhood after California's $2 tobacco tax increase. Tob Control 2019; 28:657-662. [PMID: 30409813 PMCID: PMC7560993 DOI: 10.1136/tobaccocontrol-2018-054575] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 06/19/2018] [Revised: 09/11/2018] [Accepted: 09/18/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND California's tobacco tax increased by $2.00 per pack in 2017. Although such increases are among the most effective tobacco control strategies, little is known about their impact from the perspective of corner store owners in low-income neighbourhoods with high concentrations of tobacco outlets. METHODS We interviewed 38 corner store owners and managers in San Francisco's Tenderloin, the district with the city's highest tobacco outlet density, 60-90 days following implementation of the tax increase. Questions focused on perceptions of the impact of the higher tobacco tax on their revenues, customers and tobacco company promotions. We used qualitative content analysis to identify, compare and reconcile key themes. RESULTS Most retailers reported a decline in cigarette sales, with customers buying fewer cigarettes, switching to cheaper brands or other products like marijuana, or trying to quit smoking. Retailers described challenges associated with running a small business and selling tobacco and concerns about selling a product that is 'bad' for customers' health. Contrary to expectation, tobacco companies appeared to be offering few product promotions in this neighbourhood. CONCLUSIONS Small, independent retailers' concerns, about selling tobacco and about the health and well-being of customers, suggest that such retailers may be important allies in tobacco control efforts,particularly those focused on the point-of-sale.
Collapse
Affiliation(s)
- Gladis Chavez
- School of Public Health, University of California, Berkeley, California, USA
| | - Meredith Minkler
- School of Public Health, University of California, Berkeley, California, USA
| | - Patricia A McDaniel
- Department of Social and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Jessica Estrada
- Community Health Equity & Promotion Branch, San Francisco Department of Public Health, San Francisco, California, USA
| | - Ryan Thayer
- Community Organizing Department, Tenderloin Neighborhood Development Corporation, San Francisco, California, USA
| | - Jennifer Falbe
- Department of Human Ecology, University of California, Davis, California, USA
| |
Collapse
|
45
|
Abstract
While research has demonstrated the effects of tobacco control policies on birth outcomes, there is little known about their impact on birth defects. Using 2005-2015 natality data on 26,334,854 singletons from 47 US states and District of Columbia linked to state-level cigarette taxes and smoke-free restaurant legislation, we examined the impact of tobacco control policies on birth defects by maternal race/ethnicity and education. We found that among white women with less than a high school degree, every $1.00 increase in cigarette taxes reduced prenatal smoking by 3.48 percentage points and reduced the risk of their infant having any birth defect by 0.0023 percentage points. Tax increases also reduced the risk of cyanotic heart defects, cleft palate, gastroschisis, and limb reduction. We found no evidence for associations between the enactment of smoke-free legislation, prenatal smoking and birth defects. Our findings suggest that state cigarette taxes are a population-level intervention that can help reduce prenatal smoking and the risk of birth defects.
Collapse
Affiliation(s)
- Summer Sherburne Hawkins
- Boston College, School of Social Work, McGuinn Hall, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA.
| | - Christopher F Baum
- Boston College, School of Social Work, McGuinn Hall, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA; Boston College, Department of Economics, Maloney Hall, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA; German Institute for Economic Research (DIW Berlin), Department of Macroeconomics, Mohrenstraße 58, 10117 Berlin, Germany
| |
Collapse
|
46
|
Mathauer I, Koch K, Zita S, Murray-Zmijewski A, Traore M, Bitho N, Brikci N. Revenue-raising potential for universal health coverage in Benin, Mali, Mozambique and Togo. Bull World Health Organ 2019; 97:620-630. [PMID: 31474775 PMCID: PMC6705507 DOI: 10.2471/blt.18.222638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 06/05/2019] [Accepted: 06/05/2019] [Indexed: 11/27/2022] Open
Abstract
Increasing overall fiscal space is important for the health sector due to the centrality of public financing to make progress towards universal health coverage. One strategy is to mobilize additional government revenues through new taxes or increased tax rates on goods and services. We illustrate how countries can assess the feasibility and quantitative potential of different revenue-raising mechanisms. We review and synthesize the processes and results from country assessments in Benin, Mali, Mozambique and Togo. The studies analysed new taxes or increased taxes on airplane tickets, phone calls, alcoholic drinks, tourism services, financial transactions, lottery tickets, vehicles and the extractive industries. Study teams in each country assessed the feasibility of new revenue-raising mechanisms using six qualitative criteria. The quantitative potential of these mechanisms was estimated by defining different scenarios and setting assumptions. Consultations with stakeholders at the start of the process served to select the revenue-raising mechanisms to study and later to discuss findings and options. Exploring feasibility was essential, as this helped rule out options that appeared promising from the quantitative assessment. Stakeholders rated stability and sustainability positive for most mechanisms, but political feasibility was a key issue throughout. The estimated additional revenues through new revenue-raising mechanisms ranged from 0.47-1.62% as a share of general government expenditure in the four countries. Overall, the revenue raised through these mechanisms was small. Countries are advised to consider multiple strategies to expand fiscal space for health.
Collapse
Affiliation(s)
- Inke Mathauer
- Department of Health Systems Governance and Financing, World Health Organization, Avenue Appia, 20, 1211 Geneva 27, Switzerland
| | - Kira Koch
- Department of Health Systems Governance and Financing, World Health Organization, Avenue Appia, 20, 1211 Geneva 27, Switzerland
| | - Samuel Zita
- Trade and Development Consultant, SZ Consulting, Maputo, Mozambique
| | | | - Mariam Traore
- Programme National de Lutte contre la Tuberculose, Bamako, Mali
| | | | | |
Collapse
|
47
|
Oddo VM, Krieger J, Knox M, Saelens BE, Chan N, Walkinshaw LP, Podrabsky M, Jones-Smith JC. Perceptions of the possible health and economic impacts of Seattle's sugary beverage tax. BMC Public Health 2019; 19:910. [PMID: 31288764 PMCID: PMC6617661 DOI: 10.1186/s12889-019-7133-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 06/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Taxes on sugary beverages are an emerging strategy to improve health by reducing consumption and raising revenues to support community wellbeing. However, taxes may have unintended consequences, and perceptions of these consequences may affect attitudes towards this policy. METHODS In June 2017, the Seattle City Council passed an ordinance imposing a tax on sugary beverages, effective January 1, 2018. Between October and December 2017, we recruited 851 adults in Seattle to complete a survey (telephone or online) about support for the tax and their perceptions of tax-related health and economic impacts. We first analyzed data for the full sample. We then tested for differences in participants' responses by household income level (< 260% Federal Poverty Level [FPL], ≥ 260% FPL) and across race/ethnicities using chi-square tests. Analyses used population weights and adjusted for multiple comparisons, using the Holm-Bonferroni Sequential Correction (p < 0.01). RESULTS A majority of participants supported the sugary beverage tax (59%; 95% Confidence Interval [CI]: 55, 63%) and believed that the tax would improve public health (56%; CI: 52, 60%). Most participants believed that the tax would not negatively affect small businesses (52%; CI: 48, 56%) nor result in job loss (66%; CI: 62, 70%). Most participants also perceived that the tax would not negatively impact their own finances (79%; CI: 75, 82%). However, fewer lower-income (48%; CI: 42, 53%), versus higher-income participants (61%; CI: 55, 66%), perceived that the tax would improve public health, would not result in job loss (lower-income: 58%; CI: 53, 64%; higher-income: 71%; CI: 66, 75%) and would not negatively affect their own finances (lower-income: 68%; CI: 62, 73%; higher-income: 85%; CI: 81, 88%). Compared to non-Hispanic Whites, (82%; CI: 79, 86%), a smaller proportion of non-Hispanic Blacks (63%; 95% CI: 48, 75%), and Hispanics (67%; 95% CI: 51, 79%), perceived that the tax would have negative consequences for their own family finances. CONCLUSIONS A majority of respondents supported the sugary beverage tax in Seattle. Lower-income participants were more concerned about potential financial consequences. Further evaluation of the extent to which unintended consequences occur is needed.
Collapse
Affiliation(s)
- Vanessa M. Oddo
- Department of Health Services and Center for Public Health Nutrition, University of Washington School of Public Health, 330 Raitt Hall, Seattle, WA 98195 USA
| | - James Krieger
- Healthy Food America and Departments of Medicine and Health Services, University of Washington, Box 22260, Seattle, WA 98122 USA
| | - Melissa Knox
- Department of Economics, University of Washington, 305 Savery Hall, Seattle, WA 98195 USA
| | - Brian E. Saelens
- Seattle Children’s Research Institute and Department of Pediatrics, University of Washington School of Medicine, 2001 8th Ave, Suite 400, Seattle, WA 98121 USA
| | - Nadine Chan
- Public Health - Seattle and King County and Department of Epidemiology, University of Washington School of Public Health, 401 5th Ave, Suite 1300, Seattle, WA 98104 USA
| | - Lina Pinero Walkinshaw
- Department of Health Services and Center for Public Health Nutrition, University of Washington School of Public Health, 330 Raitt Hall, Seattle, WA 98195 USA
| | - Mary Podrabsky
- Department of Health Services and Center for Public Health Nutrition, University of Washington School of Public Health, 330 Raitt Hall, Seattle, WA 98195 USA
| | - Jessica C. Jones-Smith
- Departments of Health Services and Epidemiology and Center for Public Health Nutrition, University of Washington School of Public Health, 305-G Raitt Hall, Seattle, WA 98195 USA
| |
Collapse
|
48
|
Driezen P, Nargis N, Thompson ME, Cummings KM, Fong GT, Chaloupka FJ, Shang C, Cheng KW. State-Level Affordability of Factory-Made Cigarettes among Current US Smokers: Findings from the ITC US Survey, 2003-2015. Int J Environ Res Public Health 2019; 16:E2439. [PMID: 31323981 PMCID: PMC6650842 DOI: 10.3390/ijerph16132439] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 06/24/2019] [Accepted: 06/29/2019] [Indexed: 11/16/2022]
Abstract
Cigarette affordability measures the price smokers pay for cigarettes in relation to their incomes. Affordability can be measured using the relative income price of cigarettes (RIP), or the price smokers pay to purchase 100 packs of 20 cigarettes divided by their per capita household income. Using longitudinal data from 7046 smokers participating in the International Tobacco Control (ITC) US Survey, the purpose of this study was to test whether affordability significantly changed following the US federal tax increase implemented on 1 April 2009. This study also estimated temporal trends in affordability from 2003-2015 at state and national levels using small area estimation methods and segmented linear mixed effects regression models. RIP increased slightly during 2003-2008. This was followed by a 30% increase during 2008-2010, indicating cigarettes were less affordable after the federal tax increase. RIP continued to increase during 2010-2013 but decreased during 2013-2015, suggesting cigarettes have recently become more affordable for US smokers. State-level trends in RIP were consistent with overall national trends. Controlling for other factors, a $1 increase in the state excise tax was significantly associated with a 9% increase in RIP, indicating state taxes reduced affordability. Tax-induced price increases must keep pace with underlying economic conditions to ensure cigarettes do not become more affordable over time.
Collapse
Affiliation(s)
- Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada.
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada.
| | - Nigar Nargis
- Economic and Health Policy Research, American Cancer Society, Washington, DC 20004, USA
| | - Mary E Thompson
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada
- Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada
| | - Frank J Chaloupka
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL 60612-4394, USA
- National Bureau of Economic Research, Cambridge, MA 02138, USA
| | - Ce Shang
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma, OK 73104, USA
| | - Kai-Wen Cheng
- Department of Health Administration, Governors State University, University Park, IL 60484-0975, USA
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL 60612-4394, USA
| |
Collapse
|
49
|
Segel JE, Shi Y, Moran JR, Scanlon DP. Opioid misuse, labor market outcomes, and means-tested public expenditures: a conceptual framework. Am J Manag Care 2019; 25:S270-S276. [PMID: 31361430] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
As the opioid epidemic has drawn increased attention, many researchers are attempting to estimate the financial burden of opioid misuse. These estimates have become particularly relevant as state and local governments have begun to take legal action against pharmaceutical manufacturers, distributors, and others who are identified as being potentially responsible for the worsening epidemic. An important category of costs includes those related to the effect of opioid misuse on labor market outcomes and productivity. Most published estimates of opioid-attributable productivity losses estimate the financial burden borne by society, failing to distinguish between costs internalized by individuals and those that spill over to third parties, such as state and federal governments. This article provides an overview and a conceptual framework for 2 types of labor market-related costs borne by state and federal governments that typically have not been incorporated into existing estimates, which may represent important categories of expenditures. Because detailed estimates of lost tax revenue are available elsewhere, this article focuses largely on whether, and how, to incorporate opioid-related expenses incurred by means-tested government programs into more general estimates of the economic harm created by the opioid epidemic.
Collapse
|
50
|
Blanchette JG, Chaloupka FJ, Naimi TS. The Composition and Magnitude of Alcohol Taxes in States: Do They Cover Alcohol-Related Costs? J Stud Alcohol Drugs 2019; 80:408-414. [PMID: 31495377 PMCID: PMC6739641] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/19/2019] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE At least one type of tax is applied to the sale of alcoholic beverages in all U.S. states. The purpose of this study was to characterize the composition and magnitude of alcohol taxes in states and to assess the relationship between total alcohol taxes (federal plus state) and the cost of excessive drinking. METHOD The amount of tax (in dollars per standard drink) by state was estimated from data on state ad valorem excise, specific excise, and sales taxes in 2010 obtained from the Alcohol Policy Information System and Tax Foundation. These taxes were summed, and specific excise taxes were assessed as a proportion of total state taxes. Tax data on beer were analyzed for all 50 states. Tax data for wine and distilled spirits were restricted to the 32 license states and Washington, D.C., with fully privatized distribution systems. Total alcohol taxes for the 32 license states were compared on a per-drink basis with published state estimates of the cost of excessive drinking in these states in 2010. RESULTS Specific excise taxes accounted for a weighted median of 20.1% of total state alcohol tax revenue in the 32 license states and Washington, D.C. The median total alcohol tax per drink (based on all federal and state taxes) was $0.21, which accounted for 26.7% of the median cost to government and 10.3% of the median total economic cost of excessive drinking. CONCLUSIONS Specific excise taxes account for one fifth of state alcohol taxes in the 32 license states; but even considering all tax types, total alcohol taxes account for only one tenth of alcohol-related costs.
Collapse
Affiliation(s)
- Jason G. Blanchette
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts
| | - Frank J. Chaloupka
- Health Policy Center, University of Illinois at Chicago, Chicago, Illinois
- Division of Health Policy and Administration, University of Illinois at Chicago, Chicago, Illinois
| | - Timothy S. Naimi
- Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| |
Collapse
|