The Smoker's Premium: The Effect of Higher Health Insurance Premiums on Tobacco Cessation Open Access

Liber, Alex C. (2012)

Permanent URL: https://etd.library.emory.edu/concern/etds/w3763745z?locale=en
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Abstract

This study attempted to determine if charging tobacco users more for their health insurance premiums increases tobacco cessation above predicted levels. A comparison of proportions test examined the differences in tobacco cessation rates between a cohort who were charged a tobacco surcharge and the predicted population cessation rate. The Georgia State Health Benefit Plan (SHBP) began charging a tobacco surcharge on monthly health insurance premiums in July 2005. The surcharge was applied to each enrolled employee who reported tobacco use during the past 12 months by the employee or by any of the employee's covered dependents (spouse, dependent children). A cohort of 43,034 SHBP members, who were state employees, teachers, and school support staff, were followed for 70 months (July 2005 to April 2011). The Department of Community Health (DCH) provided the raw data (non-identifiable to specific individuals) used in this research. We found that over the 70 months observation period, 46.3% of the enrollees in the SHBP cohort reported that all covered family members had quit using tobacco, a figure that was significantly different than the 13.9% that would have quit at the predicted national cessation rate. Sensitivity analysis confirmed this finding when SHBP enrollees quit in greater numbers when compared to a range of population cessation rates. We concluded that charging tobacco users a higher health insurance premium appears to significantly increase tobacco cessation rates. This study measures self-reported cessation and most likely overestimates the impact of the tobacco surcharge on cessation, but sensitivity analysis indicates that the central findings of this study hold true. This is the first study to employ empirical data to examine the effect of charging higher health insurance premiums to tobacco users and provides evidence that this rapidly spreading practice may improve the public health by increasing tobacco cessation.

Table of Contents

Contents


Introduction


Literature Review


The Tobacco Surcharge on Health Insurance


Methods


Theoretical Model


Data


Measure


Independent Variables


Research Questions


Statistical Analysis


Results


Descriptive Statistics


Research Question 1


Research Question 2


Discussion


Summary


Research


Policy Implications


Limitations


Shifting the Paradigm


Future Study


Conclusion


References


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