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2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
2004ASAP從社會福利角度看菸害防制
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2004ASAP從社會福利角度看菸害防制

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楊銘欽

楊銘欽

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  • 1. 從社會福利角度看菸害防制 楊銘欽 台大醫療機構管理研究所 2004-07-12
  • 2. 討論題綱 <ul><li>為什麼要吸菸? </li></ul><ul><li>吸菸對健康的影響為何? </li></ul><ul><li>吸菸對社會福利的影響為何? </li></ul><ul><li>如何估計吸菸的經濟成本? </li></ul><ul><li>菸害防制對社會福利的影響為何? </li></ul>
  • 3. 為什麼要吸菸? <ul><li>心理上 </li></ul><ul><li>社會上(以及經濟上) </li></ul><ul><li>生理上 </li></ul>
  • 4. 吸菸對健康的影響? <ul><li>事故發生當年之影響 </li></ul><ul><ul><li>民眾要付比較高的健保費 </li></ul></ul><ul><ul><li>排擠其他民眾接受醫療的機會 </li></ul></ul><ul><li>事故發生後多年之影響 </li></ul><ul><ul><li>民眾要付比較高的健保費 </li></ul></ul><ul><ul><li>排擠其他民眾接受醫療的機會 </li></ul></ul><ul><ul><li>吸菸孕婦產下低體重嬰兒之教養費 </li></ul></ul>
  • 5. 吸菸對社會福利的影響? <ul><li>事故發生當年的影響 </li></ul><ul><ul><li>排擠福利的經費 </li></ul></ul><ul><ul><li>早逝造成的家庭問題與社會支出 </li></ul></ul><ul><li>事故發生後多年的影響 </li></ul><ul><ul><li>吸菸孕婦產下低體重嬰兒之教養費 </li></ul></ul><ul><ul><li>貧窮個人或家庭難以改善生活 </li></ul></ul>
  • 6. 如何估計吸菸的經濟成本? <ul><li>直接成本 </li></ul><ul><ul><li>醫療費用 </li></ul></ul><ul><ul><li>因醫療所造成之交通成本 </li></ul></ul><ul><ul><li>其他因吸菸所造成財物損失 </li></ul></ul><ul><li>間接成本 </li></ul><ul><ul><li>因生病所造成之所得損失 </li></ul></ul><ul><ul><li>因早逝所造成之所得損失 </li></ul></ul><ul><li>外部成本 </li></ul>
  • 7. The Health Consequences of Smoking, A Report of the Surgeon General, 2004 <ul><ul><li>444,000 premature deaths per year were attributable to smoking </li></ul></ul><ul><ul><li>13-14 years of life shorter for somkers than non-smokers </li></ul></ul><ul><ul><li>US$75 billion per year were Spent to cure smoking related diseases </li></ul></ul><ul><ul><li>US$82.7billion were lost due to health-related economic losses annually </li></ul></ul>
  • 8. Four Major Conclusions of the 2004 Report (1/5) <ul><li>Smoking harms nearly every organ of the body, causing many diseases and reducing the health of smokers in general. </li></ul>
  • 9. Four Major Conclusions of the 2004 Report (2/5) <ul><li>Quitting smoking has immediate as well as long-term benefits, reducing risks for diseases caused by smoking and improving health in general. </li></ul>
  • 10. Four Major Conclusions of the 2004 Report (3/5) <ul><li>Smoking cigarettes with lower machine-measured yields of tar and nicotine provides no clear benefit to health. </li></ul>
  • 11. Four Major Conclusions of the 2004 Report (4/5) <ul><li>The list of diseases caused by smoking has been expanded to include </li></ul><ul><ul><li>abdominal aortic aneurysm, </li></ul></ul><ul><ul><li>acute myeloid leukemia, </li></ul></ul><ul><ul><li>cataract, </li></ul></ul><ul><ul><li>cervical cancer, </li></ul></ul><ul><ul><li>kidney cancer, </li></ul></ul><ul><ul><li>pancreatic cancer, </li></ul></ul><ul><ul><li>pneumonia, </li></ul></ul><ul><ul><li>periodontitis, and </li></ul></ul><ul><ul><li>stomach cancer. </li></ul></ul>
  • 12. Four Major Conclusions of the 2004 Report (5/5) <ul><li>The above mentioned are in addition to diseases previously known to be caused by smoking, including </li></ul><ul><ul><li>bladder, esophageal, laryngeal, lung, oral, and throat cancers, </li></ul></ul><ul><ul><li>chronic lung diseases, </li></ul></ul><ul><ul><li>coronary heart and </li></ul></ul><ul><ul><li>cardiovascular diseases, </li></ul></ul><ul><ul><li>as well as reproductive effects and sudden infant death syndrome. </li></ul></ul>
  • 13. 戒菸的效果 <ul><li>戒菸對健康有立即且持久的益處 </li></ul><ul><li>65 歲以上吸菸者如果戒菸,可降低死於菸害相關疾病的風險達 50% ;戒菸 5-10 年後,中風的風險將降至和不吸菸者相同 </li></ul>
  • 14. 不吸菸活卡久 30 歲前戒菸可避免早死 記者湯慧文、彭迪/洛杉磯報導 2004-6-22 10:54                                                         英國牛津大學一項橫跨半個世紀的調查發現,年輕的吸菸者如果在 30 歲以前戒掉菸癮,就可以避免早死的命運。 這項從 1951 年就開始進行的研究發現,長期吸菸者和非吸菸者比較起來,平均壽命會短 10 年。研究結果顯示,年輕時期就開始吸菸的人,每 4 個中會有 1 人在中年去世。 研究報告也顯示,假使吸菸者在 30 歲前懸崖,大都可以避免早死,如果在 50 歲才開始戒菸,早死的比例還是可以減半。
  • 15. 世界禁菸日 5/31 WHO <ul><li>2004 年主題: </li></ul><ul><li>菸草與貧窮 — </li></ul><ul><li>一個惡性循環 </li></ul>
  • 16. 菸草與貧窮 – 惡性循環 <ul><li>吸煙每 6.5 秒就奪走一條人命 </li></ul><ul><li>每一年讓全球經濟損失兩千億美金 </li></ul><ul><li>目前全球約有 13 億個癮君子,其中 84% 在開發中國家 </li></ul>
  • 17. <ul><li>越貧窮的人越容易染上菸癮 </li></ul><ul><li>越有可能罹患吸菸相關疾病 </li></ul><ul><li>看病次數可能更多 </li></ul><ul><li>經濟負擔更重 </li></ul><ul><li>排擠教育或改善生活的錢 </li></ul><ul><li>貧上加貧 </li></ul>
  • 18. 如何估計菸害的經濟成本? <ul><li>Smoking attributable expenditures (SAEs) for people aged 35 or older in 2000 </li></ul><ul><li>Ming-Chin Yang </li></ul><ul><li>Ching-Yuan Fann </li></ul><ul><li>Chi-Pang Wen </li></ul><ul><li>Ting-Yuan Cheng </li></ul>
  • 19. Importance of the Study <ul><li>The government of Taiwan has made controlling and preventing the adverse effects of smoking an important priority. </li></ul><ul><li>To control tobacco use, the public needs to be made aware of the health costs of smoking, or the expenditures attributed to smoking (SAEs). </li></ul>
  • 20. Purpose of the study <ul><li>To estimate the smoking attributable expenditures (SAEs) for people aged 35 or older in 2000 from the health insurer’s viewpoint. </li></ul>
  • 21. Materials and Methods 1 <ul><li>A prevalence-based approach shows such social costs as burden to the government or society over a certain period </li></ul><ul><li>An incidence-based approach shows the lifetime cost to the patients and their families. </li></ul><ul><li>The prevalence-based approach was more applicable to insurers to estimate excess costs due to smoking. </li></ul>
  • 22. Materials and Methods 2 <ul><li>The study design of this study was a secondary data analysis . </li></ul><ul><li>We estimated the amount of utilization of health care services and expenditures associated with each disease category based on epidemiologic results. </li></ul>
  • 23. Materials and Methods 3 <ul><li>The estimation of SAEs of disease associated with smoking involved three steps: </li></ul><ul><ul><li>Identifying diseases associated with smoking, </li></ul></ul><ul><ul><li>Deciding types of costs to be estimated, and </li></ul></ul><ul><ul><li>Estimating the quantity and valuing the medical resources used. </li></ul></ul>
  • 24. 1. Identifying diseases associated with smoking <ul><li>We used the results of two follow-up studies. </li></ul><ul><li>The merged cohort dataset, initiated by Wen, Tsai (t he civil servants and teachers cohort, the CST cohort ) and Chen et al. (the community cohort ) , contains more than 110,000 study subjects. </li></ul><ul><li>These studies used relative risk (RR) to identify diseases in which smokers had significantly higher mortality rates than non-smokers. </li></ul>
  • 25. 2. Deciding types of costs to be estimated <ul><li>We only estimated the expenditure of outpatient and inpatient services. </li></ul><ul><li>Taiwan’s National Health Insurance (NHI) covers more than 97% of the eligible population and will release selected annual claims data. </li></ul><ul><li>NHI cannot provide information on out-of-pocket expenditures. </li></ul>
  • 26. 3. Estimating the quantity and valuing the medical resources used <ul><li>We used the ICD9-CM code from the relative mortality rate data of the two-cohort studies as the key variable in linking NHI outpatient and inpatient claims data. </li></ul><ul><li>We chose to study only those nineteen diseases in which smokers had significantly higher mortality rates than non-smokers. </li></ul>
  • 27. 3.1 Expenditure and quantity of hospitalization <ul><li>The expenditures of per admission (for each disease, by sex and age group) </li></ul><ul><li>= Total inpatient expenditures/total number of admissions (for each subgroup) . </li></ul><ul><li>Total number of admissions (for each disease, by sex and age group) </li></ul><ul><li>= The summation of the admission by each sub-group </li></ul><ul><li>Information on inpatient services was obtained from the database released by the NHRI under the authorization of the BNHI. </li></ul>
  • 28. 3.2 Expenditure and quantity of outpatient visit <ul><li>  The calculation of outpatient expenditure per visit and quantity per disease was similar to that of inpatient service. </li></ul><ul><li>The datasets provided by the NHRI were sampled at 1 in every 500 cases. </li></ul><ul><li>To generate a quantity for the entire population, we multiplied the amount by 500. </li></ul>
  • 29. 3.3 Estimating the fraction of services attributable to smoking <ul><li>The quantity of medical services used attributed to cigarette smoking was estimated by using population attributable risk (PAR). </li></ul><ul><li>P(RR-1) </li></ul><ul><li>PAR=-------------- </li></ul><ul><li>P(RR-1)+1 </li></ul><ul><ul><ul><ul><li>Where </li></ul></ul></ul></ul><ul><ul><ul><ul><li>P: the prevalence rate of cigarette smoking in the whole population </li></ul></ul></ul></ul><ul><ul><ul><ul><li>RR: the relative risk </li></ul></ul></ul></ul>
  • 30. 3.4 Estimating morbidity cost <ul><li>MCiys=Σ[P(MD) iys x Q(MD) iys </li></ul><ul><li>+P(H) iys x Q(H)iys] x PARiys </li></ul><ul><li>Where: </li></ul><ul><li>MC: Medical cost of disease by sex, age group </li></ul><ul><li>i: type of diseases </li></ul><ul><li>y: age groups </li></ul><ul><li>s: sex </li></ul><ul><li>P(MD): Average expenditure per outpatient visits </li></ul><ul><li>Q(MD): Total number of outpatient visits </li></ul><ul><li>P(H): Average expenditure per admission </li></ul><ul><li>Q(H): Total number of admissions </li></ul><ul><li>Note: all the utilization or expenditures were for persons aged 35 and older </li></ul>
  • 31. The prevalence rate of smokers in 1990 Sex Aged 35-49 Aged 50-64 Aged 65+ Male 63.95% 65.30% 54.91% Female 4.12% 4.95% 8.35%
  • 32. 3.5 Calculating smoking attributable fraction (SAF) <ul><li>Smoking attributable fraction (SAF) represents the percentage of SAE to the expenditure of the total population </li></ul><ul><li>SAF = SAE / the total amount expended </li></ul>
  • 33. 3.6 Calculating the mean annual expenditure of the smoker and the non-smoker (1) <ul><li>The excessive annual medical expenditure per smokers </li></ul><ul><li>= Annual Medical Expenditures of the smokers </li></ul><ul><li>- Annual Medical Expenditures of the non-smokers </li></ul>
  • 34. 3.6 Calculating the mean annual expenditure of the smoker and the non-smoker (2) <ul><li>Annual Medical Expenditures of the smokers </li></ul><ul><li>= SAEs + (Total Medical Expenditure of the </li></ul><ul><li>population – SAEs of smokers) </li></ul><ul><li>x Prevalence rate of smoking </li></ul><ul><li>  </li></ul><ul><li>Annual Medical Expenditures of the non-smokers </li></ul><ul><li>= (Total Medical Expenditure of the population – SAEs of </li></ul><ul><li>smokers) </li></ul><ul><li>x (1-Prevalence rate of smoking) </li></ul>
  • 35. Results
  • 36. Table 1. Population attributable risk due to smoking by disease and age group for both sexes aged 35 and older in Taiwan, 2000
  • 37. Table 2. Smoking-Attributable-Expenditure (SAE) of outpatient by disease and age group for males aged 35 and older in Taiwan, 2000 5%
  • 38. Table 3. Smoking-Attributable-Expenditure (SAE) of outpatient by disease and age group for females aged 35 and older in Taiwan, 2000
  • 39. Table 4. Smoking-Attributable-Expenditure (SAE) of inpatient by disease and age group for males aged 35 and older in Taiwan, 2000
  • 40. Table 5. Smoking-Attributable-Expenditure (SAE) of inpatient by disease and age group for females aged 35 and older in Taiwan, 2000
  • 41. Table 6. Smoking-Attributable-Expenditure (SAE) by disease for both sexes aged 35 and older in Taiwan, 2000
  • 42. Table 7. Smoking-Attributable-Expenditure (SAE) by disease and service type for both sexes aged 35 and older in Taiwan, 2000
  • 43. Table 8 . Smoking-Attributable-Fraction (SAF) of each disease system by service type for males aged 35 and older in Taiwan, 2000
  • 44. Table 9 . Smoking-Attributable-Fraction (SAF) of each disease system by service type for females aged 35 and older in Taiwan, 2000
  • 45. Table 10 . Smoking-Attributable-Fraction (SAF) of each disease system by service type for both sexes aged 35 and older in Taiwan, 2000
  • 46. Table 11. Mean Annual Medical Expenditure for Smokers and Non-Smokers in Taiwan, 2000
  • 47. Summary of the Results <ul><li>Total SAE was US$467.3 million , representing 8.5% of the total medical expenditures for persons aged 35 and older in 2000. </li></ul><ul><li>The top three most costly diseases were </li></ul><ul><ul><li>kidney disease (US$ 90.2 million), </li></ul></ul><ul><ul><li>ischemic heart disease (US$ 63.5 millions) </li></ul></ul><ul><ul><li>accidents (US$ 47.8 million). </li></ul></ul>
  • 48. US$467.3 Million
  • 49. Discussion 1 <ul><li>This study is a major improvement over our first study of SAEs in two ways. </li></ul><ul><ul><li>The relative risk of smokers versus non-smokers was provided by two large follow-up studies. </li></ul></ul><ul><ul><li>The amount of medical care utilized by each type of disease and their corresponding expenditures came from the NHI claims files.. </li></ul></ul>
  • 50. Discussion 2 <ul><li>Percent of SAEs to the total expenditure of each service </li></ul>7.4% 10.6% 2000 Taiwan NHI This study 5.6% 11.4% 1993 U.S. Medicare Zhang et al Outpatient Inpatient Study Authors
  • 51. Discussion 3 <ul><li>The SAFs of total SAE </li></ul>8.5% Taiwan This Study 6 – 8% U.S. Warner et al SAFs Study Authors
  • 52. Discussion 4 <ul><li>SAFs </li></ul>8.2% 40% Respiratory 19.8% 25% Circulatory 23.5% 20% Neoplasm This study, 2000 Luce and Schweitzer, 1978 SAFsAuthors
  • 53. Discussion 5 <ul><li>Kidney diseases accounted for 5% of outpatient expenditures of all diseases for males. </li></ul><ul><li>About 80% of the renal dialyses are done in hemo-dialyses centers, causing the cost of insurance, reducing the productivity and quality of life of the patient. </li></ul><ul><li>Kidney disease should be a main concern when discussing the cost of smoking. </li></ul>
  • 54. Limitations <ul><li>We did not estimate SAEs related to Passive smoking or expenditures not covered by NHI. </li></ul><ul><li>We used relative risk of mortality to estimate the relative risk of morbidity of each disease. </li></ul><ul><li>We used the prevalence rate of smoking during previous decade instead of that of the current year. </li></ul>
  • 55. 菸害防制對社會福利的影響為何? <ul><li>社會福利的目標為何? </li></ul><ul><ul><li>老人福利 </li></ul></ul><ul><ul><li>婦女福利 </li></ul></ul><ul><ul><li>兒童及青少年福利 </li></ul></ul><ul><ul><li>身心障礙者福利 </li></ul></ul><ul><ul><li>社會救助 </li></ul></ul><ul><ul><li>社會保險 </li></ul></ul>
  • 56. Thank You for Your Attention!

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