PART I
A. Background of the Study
Smoking has been associated with several health problems such as heart diseases, respiratory diseases and cancer. Since smoking is an addictive activity, smokers have incurred the impression that they spend high costs on health care. They react to ailments and diseases associated with smoking by spending on medicine and medical services but they find difficulties in quitting the habit (Longest, 2009).
B. Statement of the Problem
1. Research Question
Does smoking result to high costs in health care? This study will seek to address whether smoking could enable affected people to have more health care-related expenditures. The fact that many people are addicted to smoking gives the impression that they might have spent more money on medicine due to the health consequences such habit brings.
2. Hypothesis
As per hypothesis, smokers have high health care costs. Their habit, which is by no means beneficial to their health, could lead to particular diseases depending on the aggravation brought by its frequency. Studies have adequately established that smoking could potentially damage several parts of the body; hence, it would be reasonable to assert that such may be costly on the part of smokers.
C. Objectives of the Study
This study will seek to prove that smoking has costly consequences in terms of health care expenditures. The wide range of literature in the field of medicine has proven that smoking could cause adverse health effects, so much to the point that it has become common parlance that smoking causes nothing but harm, despite its addictiveness. That premise alone draws a possible link to higher health care costs, since smokers would tend to spend money on health care just to alleviate any discomforts connected to their habit, whether they make the effort to stop or not. In that way, there would be an implication that smoking is not only harmful to anyone’s health but also to anyone’s finances.
PART II
D. Literature Review
As proven by numerous studies, smoking stands as a habit that provides heavy risks to those practicing it. At the same time, the addictiveness of such habit has remained a major problem, as it potentially leads to higher health care costs that could provide heavy burdens on smokers. Many studies have tackled that particular aspect, albeit within different settings and timeframes.
Barendregt, Bonneux and van der Maas (1997) established in their study that smoking could definitely lead to higher health care costs but only for the short term, whereas those who are non-smokers could possibly incur more health care costs as they advance in age. The perspective employed by the researchers in this study bears high relevance to time, as they have perceived smokers as people who have shorter lifespans than non-smokers do. The various diseases associated with smoking could translate to higher health care costs yet could lead to the earlier deaths of smokers. Non-smokers, on the other hand, tend to live longer and thus face the prospect of spending more on smoking due to other diseases that could affect them in later life. To arrive at those findings, the researchers used three types of life tables – one characterizing a mixed population of smokers and non-smokers, one for purely smokers and another for purely non-smokers. The researchers have concluded that smokers could incur higher health care costs for the short term, but in a span of 15 years non-smokers could have higher health costs due to other sicknesses, which could require health care solutions that are costlier compared to those caused by smoking (Barendregt, Bonneux and van der Maas, 1997).
Leu and Schaub (1983) established the same finding in an earlier study, directly contending that non-smokers incur higher health care costs because they have a longer life expectancy compared to smokers. Those who do not smoke face the possibility of spending more money for health care in later stages of their life, although such could meet a viable counterbalance in the form of under-utilization of health care since the healthier non-smokers could be, the lesser the chances that they have to spend on health care. The researchers firmly held that quitting smoking would not likely decrease health care costs (Leu and Schaub, 1983).
Izumi et al. (2001) conducted a research identifying the amount of excess health care benefits Japanese smokers use between 1994 and 1995, coming up with the initial assumption that they use more excess health care compared to non-smokers. The study went through within 30 months, including respondents that are National Health Insurance (NHI) beneficiaries between 40-79 years of age living in a rural area. Using NHI claim history files within the period, the researchers were able to monitor the health care usage of their respondents. Their findings reflected that male smokers have spent 11% more on health care costs than their non-smoking counterparts, although findings for female smokers and non-smokers are almost at level. Smokers, in general, have spent 33% more per month in inpatient care, thus prompting the researchers to recommend a more comprehensive program for curtailing smoking, due to its harmful and costly effects to health and health care costs, respectively (Izumi et al., 2001).
Ruff et al. (2000) conducted an identical study in Germany. The researchers sought to measure the health costs related to smoking based on the following diseases: cancer (lung, mouth and larynx), coronary artery disease, stroke, atherosclerotic occlusive disease and chronic obstructive pulmonary disease. Using data from the German Institute for Medical Documentation and Information, MEDLINE, the Internet and several databases of insurance companies, the study found that around 47% of the health care costs of the aforementioned diseases have connections to smoking, with the most significant amount coming from lung cancer (89%). Thus, it shows that many health care insurance holders with those diseases have derived problems from smoking, thus the researchers have recommended for stronger efforts in regulating smoking in order to help prevent those in the future (Ruff, et al., 2000).
Fishman et al. (2003) engaged in a similar study in the US state of Washington, although the researchers focused on former smokers whose cessation may have influenced health care costs. Compared to continuing smokers, former smokers have higher health costs after one year of quitting, but that figure falls down at a statistically indeterminable rate at the second year. In that case, it would be safe to conclude that quitting smoking would not necessary translate to higher health care costs all throughout. From the second year of cessation thereon, the rate of health care costs reached the same level as those continuing smokers (Fishman, et al., 2003).
Smoking is not just the only health anomaly that has characterized high health care costs. Sturm (2002) justifies that in his study by correlating smoking to obesity and drinking. The researcher has found that obesity produces the same chronic effects on people as that of those who are twenty years older – a rate that is higher than that of smokers and drinkers. Obese people have health care cost increase rates of 36% in inpatient and outpatient costs and 77% in medications, compared to 21%:28% for smokers and a smaller ratio for drinkers. The study, however, acknowledged that smoking and drinking have been the subject of more public health advocacies than obesity, in which he calls for a more intense campaign for the latter (Sturm, 2002).
Health care costs do not just come from the expenditures borne by smokers through their health insurance memberships or even personal expenses. Such could also come from the amount of money medical institutions spend on educating smokers to quit smoking. Windsor et al. (1993) conducted a study specific to that using pregnant women as their main respondents. The researchers gathered a group of four hundred pregnant women and divided them into two groups (Experimental E Group and Control C Group) for anti-smoking education in a public health maternal clinic, subject to observation on three different periods – first visit, mid-pregnancy and post-pregnancy. Those women confirmed that they have smoked within those three different periods. At the end of the sessions, the E Group reported a quit rate of 14.3% and the C Group reported a quit rate of 8.5%. With cost-to-benefit ratios ranging from $1:$6.72 and $1:$17.18, the researchers concluded that efforts to curtail smoking through education are effective (Windsor, et al., 1993).
PART III
E. Research Methodology and Limitations
This study will be primarily made of secondary data coming from previously conducted studies, as there is a wide range of studies in the field that employed several data gathering techniques but in different areas. Prevalent throughout the literature used for this study is the use of health insurance records of smokers in determining the rate of health care costs spent on smoking, alongside particular correlations with other health conditions such as obesity and drinking (Longest, 2009). This study, however, has severe limitations on the lack of new data found in the field. For this study has the purpose to be a descriptive one seeking to establish that there are high health care costs due to smoking, the main problem would be the lack of new data affirming the results generated by the literature. Yet, as apparent upon perusal of the literature at hand, findings constitute practical considerations observable within different periods. No game-changing innovation or any possibility thereof have been cited by the literature used herein, further strengthening the veracity of the findings. The lack of more recent findings, thus, does not lack the integrity of the findings.
PART IV
F. Findings and Discussion
This study has generated findings affirming that smoking is a condition that leads to higher health care costs, although such does not mean that such disease is altogether costly, as offset by factors including life expectancy and corrective measures.
Life expectancy is a major factor concerning smoking. Several studies have found and acknowledge that smoking shortens the life expectancy of an individual. Thus, it is proper to assume, for the purposes of this study or wherever applicable, that smokers have expectedly shorter life spans. Smoking could trigger different diseases affecting the heart, respiratory system and other parts of the body. With more diseases to contend, smokers thus face greater risks to their lives. Yet, the amount of diseases smokers could incur does not reflect steadfastly larger costs in health care. Barendregt, Bonneux and van der Maas (1997) aptly demonstrated that non-smokers face the risk of higher health care costs in later life, since they have more potential to face more diseases as they advance with age. They acknowledge, however, that smokers could generate higher health care costs for the short term, as they are set to counter the diseases they incurred from smoking through outright usage of any resources that would avail them of health care, such as health care insurance. Lee and Schaub (1983) came up with a similar finding in an earlier study. They contended that the shorter lifespans of smokers could enable them to have lower health care costs incurred by those nonsmokers who have the potential to live longer. Additionally, they concluded that smoking cessation, or quitting from smoking, would not lead to lower health care costs. The health care costs of non-smokers may still depend on whether they choose to spend on health care or not, the need of which arises when they, themselves, encounter diseases from other causes (Longest, 2009).
The study further revealed that smokers tend to generate high usage of their health insurance benefits, based on several perusals of health insurance records. Izumi et al. (2001) noted that male Japanese smokers tend to overspend their NHI benefits by 11% compared to male Japanese non-smokers – a rate significantly higher than that of female Japanese smokers and non-smokers. In sum, Japanese smokers form 33% monthly of inpatient care costs. A similar case fell on German smokers studied by Ruff et al. (2000), as they limited their study through using diseases most commonly associated with smoking. They found that 47% of the cases of the diseases they have cited have causes from smoking, thus revealing that smoking is a threat to both the health and health insurance expenditures of smokers. Fishman et al. (2003), who studied the cases of smokers in the US state of Washington, used the factor of smoking cessation in determining the impact of smoking on health care costs. He found that smoking cessation could lead to health care costs higher than that of smokers only during the first year of quitting, perhaps due to early withdrawal effects that follow. For the second and succeeding years, health care costs begin to normalize to the level of smokers, although it may rise again due to the extension of life expectancy. Overall, the three studies call for the importance of stronger public health advocacies against smoking, as those have shown that smoking could generate high health care costs, despite the purportedly larger figures associated with non-smokers. Verily, the studies have emphasized that it is more desirable to have a longer life with naturally higher health care costs than a shorter life due to smoking that has high health care costs at the same time.
Findings also reflected that smoking, while being a preventable habit leading to adverse health conditions, does not generate the highest costs in health care. Sturm (2002) proved that in his study of smoking alongside obesity and drinking, in which he found that obesity has higher health care costs compared to smoking and drinking. Yet, what is significant in his study is the fact that of the three health conditions, smoking came in as the second costliest. As he called on for stronger health advocacies to prevent the spread of obesity, he acknowledged that efforts to curb smoking and drinking have increased, implying that there has been considerable development on such matter. In terms of health care costs related to smoking spent on education, there has been a significant showing that investing money for educating smokers against smoking has proven effective. Windsor et al. (1993) sampled pregnant women smokers for the purposes of their study. They found that educating pregnant women against smoking has proven effective due to the significant quit rates that followed from the education sessions. Such imply that health care costs in that aspect did not end up in vain. Rather, it somewhat reflected the emphasis of the studies of Barendregt, Bonneux and van der Maas (1997), Izumi et al. (2001) and Ruff et al. (2000).
G. Conclusion and Recommendation
This study has been able to establish that smoking is a costly habit that makes up for a significant percentage of health care costs. Although it is not the only disease that triggers high costs for health care, it is nevertheless a significant one that deserves due regulation. Yet, there are particular findings that limited the extent in which smoking could become costly. Two factors characterize that – life expectancy and corrective measures.
Factoring life expectancy in provides the recognition that smoking is a habit that shortens the lifespan of those practicing it. Smokers, deemed to have shorter lifespans, have greater exposure to different diseases affecting crucial parts of the body such as the heart and respiratory system. Non-smokers, on the other hand, may not suffer the same frequency and occurrence of diseases associated with smokers, but their longer lives expose them to greater potential of having to spend more on health care due to diseases other than those associated with smoking. At the same time, non-smokers, being generally healthier than smokers, may have the option not to spend on health care at all, depending on their health condition. After all, non-smokers do not necessarily equate to fully healthy people, as they could also be subject to other health risks such as stress, overeating leading to obesity, health problems due to drinking and others aside from smoking. Thus, the notion of life expectancy in analyzing potential health care costs of smokers may prove to be a balancing factor to the commonly held premise that non-smokers have lesser health care costs to reckon.
Several studies in the literature have raised the need to advocate against smoking. Such has found justifications from studies in Japan, Germany and the state of Washington in US, which reflected cases of high usage of health insurance benefits on smoking-related diseases. Japanese smokers are excessive in terms of their usage of NHI in treating themselves against diseases triggered by smoking. Cases of specified diseases in Germany have reflected findings related to Germany, reflecting a large percentage of cases in health care expenditures. Those who have quit smoking in Washington did not have smaller health care costs contrary to the common assumption. They had higher health care costs in their first year of quitting due to withdrawal effects and the succeeding years have normalized but still subject to potential rise, as affected by the extension in life expectancy. The acknowledgement of rising efforts to advocate against smoking and drinking, with the lack thereof in the case of obesity, shows that investments on advocating against smoking have risen. The case on educating pregnant women against smoking shows that health care costs on educating against smoking have become highly effective due to its purported effects of making smokers – pregnant women, in this case, quit.
As this study has found several supporting data on the premise that smoking could lead to high health care costs, there arises the need for key considerations on the matter. Firstly, there has to be intensified campaigns against smoking. Those campaigns have become the subject of recommendations of previous studies and it has proven itself effective in making smokers quit their habit. Secondly, it is essential for smokers and non-smokers alike to consider other health risks that they are facing. Smoking is not the only health risk that could increase health care spending. There must be a consideration of other factors such as obesity, drinking, stress and other triggers in order to have a deeper understanding on health care expenditures. Smoking may be dangerous and costly to smokers, but non-smokers have to be wary that they are not completely safe from the effects of diseases and costs in health care. Their lengthier lifespans opens them to more possibilities of getting sick, thus they have to be mindful of their health as well. Thirdly, it is essential to think that despite the exposure of non-smokers to higher health care costs compared to smokers who spend more on health care for the short term, it is always better to have a longer lifespan despite possibilities of higher health care costs than a shorter lifespan due to smoking coupled with guaranteed higher expenditures on smoking. Non-smokers win at the end of the day since they have the prospect of not spending much on health care due to better health and thus, lengthier lifespans.
References
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Fishman, P., Khan, Z., Thompson, E., & Curry, S. (2003). Health care costs among smokers, former smokers, and never smokers in an HMO. Health Services Research, 38(2), 733-749.
Izumi, Y., Tsuji, I., Ohkubo, T., Kuwahara, A., 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. International Journal of Epidemiology, 30, 616-621.
Leu, R., & Schaub, T. (1983). Does smoking increase medical care expenditure? Social Science & Medicine, 17(23), 1907-1914.
Longest, B. (2009). Health policymaking in the United States. Chicago, IL: Health Administration Press.
Ruff, L., Volmer, T., Nowak, D., & Meyer, A. (2000). The economic impact of smoking in Germany. European Respiratory Journal, 16, 385-390.
Sturm, R. (2002). The effects of obesity, smoking, and drinking on medical problems and costs. Health Affairs, 21(2), 245-253.
Windsor, R., Lowe, J., Perkins, L., Smith-Yoder, D., Artz, L., Crawford, M., Amburgy, K., & Boyd, N. (1993). Health education for pregnant smokers: Its behavioral impact and cost benefit. American Journal of Public Health, 83(2), 201-206.
