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

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

About this Master's Thesis

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School	Rollins School of Public Health
Department	Health Policy and Management
Degree	MSPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	tobacco cessation The Effect of Higher Health Insurance Premiums on Tobacco Cessation health insurance premiums health insurance tobacco surcharge tobacco control smoker's premium
Committee Chair / Thesis Advisor	Howard, David H, Emory University
Committee Members	Ross, Hana , Emory University Gaydos, Laura, Emory University Lipscomb, Joseph, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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