Smoking And Healthcare: The True Costs Of “Lighting Up” Research Paper Example

Type of paper: Research Paper

Topic: Health, Smoking, Health Care, Study, Medicine, Tobacco, Education, Business

Pages: 10

Words: 2750

Published: 2020/11/24

Smoking and impact to healthcare costs

Thesis Statement: Smoking impacts other sectors apart from the health care system, and inflicts other burdens as well.
In the report of Tiihonen, Ronkainen, Kangasharju, and Kauhanen (2012), the authors note the grim figures that smoking inflicts upon a society. In their work, smoking is the “single most preventable cause of premature death in developed nations. In addition, the report cites the practice of levying taxes as the most prevalent method to try decreasing the number of smokers in their respective countries. The main effect of levying taxes is a reduction in the number of new smokers. It has been approximated that a 10 percent rise in the prices of tobacco products-cigarettes, cigars- will translate to a 5 percent decrease in consumption rates for cigarettes; however, taxes from tobacco products are relatively low in a number of countries.
Society incurs monetary as well as other costs from smoking. For instance, smoking decreases the life span of the person and inflicts additional burdens on the nation’s health care system. Legislators that approved landmark healthcare laws justified their approval by characterizing the massive costs linked to smoking. In approving the law that gave the United States Food and Drug Administration (FDA) the mandate to monitor tobacco-related products, the advocates cited statistics derived from the Centers for Diseases Control and Prevention of the abovementioned expenses that smoker inflict on the government healthcare resources.
Prevailing literature on health economics evinces two primary considerations. One, smoking drives up health care expenditures, and two, that constraints placed on smoking will translate to a parallel reduction in the prevalence of smoking. Some analysts have theorized that these two considerations, when combined, allows for the development of an assumption that placing heavy restrictions will result in a lower occurrence of smoking. There are reasons nevertheless, that evidenced smoking and health care expenditures on one side and implementation of policies and regulations related to smoking. In the resolution of the study, the combination of the two does not imply a causal impact on the limitations on health care. In this light, it was seen that increases in taxes will translate to an increase in cessation statistics (Moore, Hughes, 2000, p. 1).
Though the tobacco sector is among the largest and most successful industries, its main product is one of the deadliest compared to other manufactures. A market examination of the market for tobacco products has shed significant light on the discussions on the status of the sector in the society and the manner that public policies are crafted to deal with the growing health menace being attributed to tobacco. The most powerful example is the swiftly extending and advanced body of literature on the impacts of price adjustments on the cigarette consumption. As excise levies are variables of price, the prevalent literature is evidenced in discussions in legislative debates regarding taxation as a mechanism to sway public opinion against smoking (Chaloupka, Warner, 1999, p. 1).
In the United States, the ratio is that for each $10 that is allocated and used in health care costs, nearly 90 cents results from smoking illnesses. With new health and medical expenditure surveys, analysts computed that 8.7 percent of collective health care expenses, or approximately $170 billion annually, are for conditions resulting from smoking; much of the expenses were paid by government programs such as Medicare and Medicaid.
According to the data of the CDC, 18 percent of the adult population in the United States smoke cigarettes and the mortality rate in that demographic is one out of every five deaths is due to smoking. Xin Xu, who led the CDC research study, correlated the data on expenditures for healthcare from the “Medical Expenditure Survey (2006-2010) with that of the “National Health Interview Survey (2004-2009) for a national representation of smoking practices and the relation to costs.
The group found that of the lot, approximately 40,000 persons, 21.5 percent of the sample was present smokers, while 22.6 percent of the lot had quit smoking and 56 percent had never smoked. The analyzed utilized previous data on smoking associated illnesses and mortality to compute the expenses related to health care by each individual linked to smoking.
In addition, the researchers fine tuned their statistics for variables such as unreasonable drinking, corpulence, and socioeconomic factors, and computed the proportion of the expenses by each payer. In the examination of the data, 9.6 percent of expenses from Medicare, 15.2 of Medicaid expenses, and a significant 32.8 percent from a number of government health care expenditures, inclusive of the Veterans Affairs Office, Indian Health Services, and “Tricare” all pointed to smoking as the cause of their expenses.
It was estimated that out of the $170 billion expended on paying for smoking related health care services, 60 percent of the amount was remunerated from government sources, as cited from the American Journal of Preventive Medicine (Volume 48, Issue 3) (Xu, Bishop. Kennedy, Simpson, and Pechahek, 2014). What is more troubling are the findings that smoking impacts other health care related expense items as well.
In the opinion of University of Michigan School of Public Health Dean Kenneth Warner, aside from adverse lung and heart conditions, smoking also negatively impacts the eyes, skin and contributes to the development of numerous cancers, inclusive of bladder and pancreatic malignancies. In this light, Warner avers that besides the agonizing pain that smoking inflicts on a smoker, the practice encumbers an enormous burden on America’s healthcare facilities, particularly the ones that are being funded by the public by way of taxes. Unfortunately, the costs, actual and otherwise, are actually larger than what is on paper (Kennedy, 2014, p. 1).
In the study of Izumi, Tsuji, Ohkubo, Kuwahara, Nishino and Hisamichi (2001), the study conducted by this group supplemented existing knowledge sets on the impact of smoking on medical and health care expenses. The effect, as noted in the research, was dissimilar comparing the results of inpatients and cases. The study shows that smokers utilized outpatient facilities at lower rates compared to non-smokers. This can be attributed to the wanton disregard of smokers for their health condition. This antagonism towards seeking medical attention at earlier stages of the illness can result in a worse outcome for their conditions.
Nevertheless, the research was restricted in that the efforts examining the impact of smoking on medical expenses was apparent for men, but was ambiguous in women. This was due to the low rate for women measured at 11 percent and the time period for the sample was relatively shorter compared to those for current and former male smokers. Two, the measurement time period in the research was limited to 30 months. The period, it is held, is too insufficient to factor in the higher mortality rate of smokers as well as the attendant rise in terminal care, and can underestimate the superfluous medical expenses (Izumi, Tsuji, Ohkubo, Kuwahara, Nishino and Hisamichi, 2001, p. 1).
Among the states, the highest rate for deaths related to smoking was disclosed in Kentucky, with 370 deaths per 100,000 individuals; the lowest rate was reported in Utah, with 138 per 100,000 individuals. The grim statistics will not only be felt by adults; prevailing usage patterns will result in an estimated 6 million children will lose their lives from a smoking induced illness. One research study posits that a larger decrease in the frequency of smoking would translate to larger reductions in the expenditures related to smoking.
In the 2006 disclosure of the Surgeon General, the report empathically notes that with regard to second hand smoke, there is no tolerable and safe exposure level, and even short term vulnerability exponentially raises the threat of cardiac arrest. A 2009 Institute of Medicine report proved that second hand smoke is a major trigger of heart attacks, and that even a short exposure to this can lead to a heart attack. This is due to the lethal contents of second hand smoke, inclusive of benzene, vinyl chloride, hydrogen cyanide, and formaldehyde.
Even the industry acknowledges this morbid fact; research activities as early as the 1980s by tobacco giant Philip Morris disclosed that second hand smoke was deadly; the company went on to hide these results for the succeeding 20 years. Not only adults are under threat from this; children are in peril due to exposure from second hand smoke. It is estimated that 50-75 percent of children in the United States have measurable amounts of “cotinine,” the end product of nicotine in the body (American Lung, 2015, p. 1).
The World Health Organization (2015) notes that should present archetypes persist, smoking or the use of tobacco products will result in the deaths of 8 million individuals by the year 2030. Furthermore, it is estimated that half of world’s smokers, estimated at 500 million individuals, will die from a smoking-related illness. Apart from health concerns, the economic burden of consuming tobacco products is equally if not inordinately crushing. More than the overwhelming expenditures associated with smoking, smokers and tobacco product consumers negatively impact the economy as well.
It has been seen that smokers in terms of production output are lagging behind non-smokers. This is attributed to increased instances of illness-related variables, and the premature deaths of smokers whose families are in turn deprived of the income that should have been generated and made available if not for the death of the smoker-“bread winner.” Withal, the link between tobacco product use and marginalization is also shown. There are studies that have evidenced the fact that in the most impoverished households in Third World countries, it was discovered that more than 10 percent of the household expenditures were for purchasing cigarettes.
Simply put, the money that could have been used to purchase food, secure health care services, or pay for the education of the children of the smokers was instead spent for cigarettes. Illiteracy and undernourishment are also related effects of smoking; the money that could have been spent on spending for the education of the children or buying sufficient food resources for the family was spent on tobacco products. Here, it can be stated that smoking worsens poverty and blocking economic progress, and should remain a critical area of study for mitigation (Tobacco Free Initiative, 2015, p. 1).
Izumi, Tsuji, Ohkubo, Kuwahara, Nishino and Hisamichi (2001) notes that the health risks of smokers results in the instance where smokers use more resources compared to the rate of non-smokers; hence, smokers pose a greater expense to the health care system. Rice et al (1986) discovered that the amount of time smokers remained confined in hospitals and the amount of doctor consultations were dramatically higher than the number for non-smokers. In addition, smokers were expected to have an “excess lifetime medical expenditures” amounting to 43 percent for men and approximately 29 percent for women.
However, the opposite position is that smoking actually benefits government coffers. Smokers die 10 years earlier compared to the lifespan of non smokers; these untimely deaths help in generating savings for government programs such as pensions, Social Security, Medicare, as well as other funding programs. In the study of Kip Viscusi, a financial expert with Vanderbilt University, in analyzing the costs vis-à-vis the benefits of smoking, it was found that for every cigarette pack consumed, the United States derives savings up to 32 cents.
However, Viscusi notes that the instance looks distasteful or grim to view the cost-savings in this manner and acknowledge that smoking results in unnecessary and untimely deaths. Nevertheless, Viscusi also notes that if one were to reach the objective of the “cost-savings” approach, one has to factor in all of the possible impacts, and not the ones that will support the passage of a specific law or policy.
Another interesting assertion is that healthy people inflict more costs to the healthcare system than smokers or ill people. One Dutch research study released in the Public Library of Science Medicine Journal disclosed that the health care system incurs an expense that reaches up to more than $320,000 when the person reaches the age of 20 years old or older; this figure is dwarfed by the $417,000 for the same bracket for non smokers and healthy people. University of Chicago-Harris School of Public Policy Studies health economics and policy professor Willard Manning brings the issue back to an American context.
Manning, the head writer on a research paper published nearly 20 years ago in the Journal of the American Medical Association. In the paper, Manning factored in the costs of the taxes that were being levied at the time of the study. Manning’s conclusion: Smokers were not a burden to government coffers. These findings were highly contentious given that smoking is given a beneficial impact to untimely deaths. It is understandable why US government agencies tend to wince at such data (Werner, 2009, p. 1).
The net impact on health care expenditures has been evidenced in a number of studies. A number of studies have proffered that though smokers will be subjected to more severe negative health consequences from a number of health related diseases, non-smokers will prove to be more expensive and cumbersome for the health care system owing to their extended life span. Other studies, however, have stated the opposite of this position.
A limited number of studies have factored in the costs of smoking on pensions and insurance premiums, and collected taxes from tobacco products. Reports have displayed the benefits of smoking on a country’s economy; however, the data collected from this activity was anchored on “theoretical modeling.” In addition to this weakness, the data gathered did not equate a monetary comparison for the life that was lost due to smoking, and the value of the costs related to smoking inclusive of medical care was grossly underestimated.
The general effects of smoking on personal as well as extraneous expenses have been studied by Sloan and his colleagues (2004) and by Viscusi (1999) utilizing American “life table data” to process expected net expenses resulting from smoking. In the study of Baal et al (2011), marginally varying models can in turn give significantly digressing results on smoking’s net impact; these are dependent on the assumptions set for the justification of the use of the model used.
Nevertheless, advanced instance anchored data will eventually be obligated to disclose the actual costs attributable to smoking. As there have been no definitive results derived from expected, individual based information founded on the factors of death, morbidity, health care expenses and annuities, the “net economic impact” of smoking is vague (Tiihonen, Ronkainen, Kangasharju, and Kauhanen, 2012, p. 1).
In this light, the authors note the curious scenario that these countries are willing to increase budgetary allocations for health care services and at the same time not raise taxes. Raising taxes can result in the generation of sizable revenue streams for the government, produce considerable savings as well as fund scientific technologies to prolong life spans, all from raising the level of taxes being collected by government agencies.
The American Lung Association (2015) reports that “smoking-related diseases” results in the unnecessary deaths of more than 390,000 lives yearly; in 2004, the United States incurred approximately $190 billion ; $97 billion in wasted productivity and $96 billion in “direct health care expenditures;” divided per smoker, the amount that the US government loses is more than $ 4,200 per person. The studies of et al (2001) examined the link with smoking vis-à-vis use of medical resources with the use of cross-sectional literature data; collective data evincing long term costs were deduced by using theoretical formulas.
The evaluation of the models were restricted as these did not completely the interaction of smoking and other variables such as the smoker’s age, the state of the person’s age, and health attendant factors. Though a number of anticipated empirical studies have examined the issue, the sizes of the samples were too insignificant to permit “statistical adjustment” or structured analysis.
The effects of smoking related to health care costs can be more severe in other countries; nations such as Japan have higher rates for smoking compared to Western states. In a national poll, at least 50 percent of Japanese adult males and at least 11 percent of adult females are smokers in the country; nevertheless, there has been no extensive study on the relationship of smoking and that of medical expenses.
In an effort to reduce smoking efforts, extensive programs such as restricting advertisements and raising tobacco excise levies to finance counter-tobacco health projects have been recommended in a number of countries. Smoking discontinuance programs for present smokers, inclusive of “nicotine replacement therapies” have proven to be useful and cost-efficient (Izumi, Tsuji, Ohkubo, Kuwahara, Nishino and Hisamichi, 2001, p. 1).
Initiatives to combat smoking must be aggressively pursued not only to sustain decreasing smoking instances, but to avoid additional untimely deaths. Strategies including restricting access to minors, banning smoking in public areas as well as workplaces, and reduction of advertisements can help in sustaining the efforts to reduce the threat of smoking to the public (American Lung, 2011, p. 1).


American Lung Association (2015). “Smoking.” Retrieved 23 February 2015 from <
American Lung Association (2011). “Trends in tobacco use.” Retrieved 23 February 2015 from <
Chaloupka, F.J., Warner, K.E. (1999). “The economics of smoking.” Retrieved 23 February 2015 from <
Izumi, Y., Tsuji, I., Ohkubo, T., Kuwahara, Y., Nishino, Y., Hisamichi, S. (2001). Impact of smoking habit on medical care use and its costs: a prospective observation of National Health Insurance beneficiaries in Japan. The International Journal of Epidemiology Vol. 30, issue number 3 pp. 616-621
Kennedy, M (2014). “Cigarette smoking costs weigh heavily on the health care system.” Retrieved 23 February 2016 from <
Moore, M.J., Hughes, J. W. (2000). “The health care consequences of smoking and its regulation.” Retrieved 23 February 2015 from <
Tiihonen, J., Ronkainen, K., Kangasharju, A., Kauhanen, J. (2012). The net effect of smoking on healthcare and welfare costs. A cohort study. British Medical Journal Volume 2 issue 6
Tobacco Free Initiative (2015). “Why tobacco is a public health priority.” Retrieved 23 February 2015 from <
Werner, E. (2009). “Do smokers cost society money?” Retrieved 23 February 2015 from <

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