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1.
BMJ ; 379: o2815, 2022 11 22.
Article in English | MEDLINE | ID: covidwho-2152958
2.
BMC Health Serv Res ; 22(1): 1366, 2022 Nov 17.
Article in English | MEDLINE | ID: covidwho-2139278

ABSTRACT

BACKGROUND: Medicine shortages are often described in plain numbers, suggesting all shortages have a uniform impact. However, some shortages have a direct and serious effect on patients and need a prompt reaction from stakeholders. This study aims to create a broad framework to assess the impact of a shortage. METHOD: We identified high impact shortages and selected exemplary shortages which we considered our learning cases. From five learning cases, we identified elements that had a potentially profound impact on one or more of these cases. We tested data saturation on the elements with another five test cases. Based on these elements, we created a framework to assess impact of shortages on patients and presented practical examples how to rate these different elements. Subsequently, we visualised the impact of these five learning cases on patients in radar charts. RESULTS: The five elements which we identified as potentially having a large impact were 1) alternative product, 2) disease, 3) susceptibility, 4) costs and 5) number of patients affected. The five learning cases rated high on different elements, leading to diverse and sometimes even opposite patterns of impact. CONCLUSION: We created a framework for assessing the impact of a medicine shortage on patients by means of five key elements. By rating these elements, an indication of the impact can be obtained.


Subject(s)
Costs and Cost Analysis , Humans , Netherlands
3.
Proc Natl Acad Sci U S A ; 119(48): e2201266119, 2022 Nov 29.
Article in English | MEDLINE | ID: covidwho-2133956

ABSTRACT

Health authorities have highlighted "pandemic fatigue" as a psychological consequence of the COVID-19 pandemic and warned that "fatigue" could demotivate compliance with health-related policies and mandates. Yet, fatigue from following the policies of authorities may have consequences far beyond the health domain. Theories from the social sciences have raised that real and perceived costs of policies can also drive sentiments of discontent with the entire political establishment. Integrating theories from the health and social sciences, we ask how pandemic fatigue (i.e., perceived inability to "keep up" with restrictions) developed over the pandemic and whether it fueled political discontent. Utilizing longitudinal and panel surveys collected from September 2020 to July 2021 in eight Western countries (N = 49,116), we analyze: 1) fatigue over time at the country level, 2) associations between pandemic fatigue and discontent, and 3) the effect of pandemic fatigue on political discontent using panel data. Pandemic fatigue significantly increased with time and the severity of interventions but also decreased with COVID-19 deaths. When triggered, fatigue elicited a broad range of discontent, including protest support and conspiratorial thinking. The results demonstrate the significant societal impact of the pandemic beyond the domain of health and raise concerns about the stability of democratic societies, which were already strained by strife prior to the pandemic.


Subject(s)
COVID-19 , Pandemics , Humans , COVID-19/epidemiology , Health Policy , Social Sciences , Costs and Cost Analysis
4.
BMC Health Serv Res ; 22(1): 1364, 2022 Nov 17.
Article in English | MEDLINE | ID: covidwho-2115847

ABSTRACT

OBJECTIVE: Primary health care (PHC) is widely perceived to be the backbone of health care systems. Since the outbreak of COVID-19, PHC has not only provided primary medical services, but also served as a grassroots network for public health. Our research explored the accessibility, availability, and affordability of primary health care from a spatial perspective, to understand the social determinants affecting access to it in Hong Kong. METHOD: This constitutes a descriptive study from the perspective of spatial analysis. The nearest neighbor method was used to measure the geographic accessibility of PHC based on the road network. The 2SFCA method was used to measure spatial availability and affordability to primary health care, while the SARAR model, Spatial Error model, and Spatial Lag model were then constructed to explain potential factors influencing accessibility and availability of PHC. RESULTS: In terms of accessibility, 95% of residents in Hong Kong can reach a PHC institution within 15 minutes; in terms of availability, 83% of residents can receive PHC service within a month; while in terms of affordability, only 32% of residents can afford PHC services with the support of medical insurance and medical voucher. In Hong Kong, education status and household income show a significant impact on accessibility and availability of PHC. Regions with higher concentrations of residents with post-secondary education receive more PHC resources, while regions with higher concentrations of high-income households show poorer accessibility and poorer availability to PHC. CONCLUSION: The good accessibility and availability of primary health care reflects that the network layout of existing PHC systems in Hong Kong is reasonable and can meet the needs of most residents. No serious gap between social groups further shows equality in resource allocation of PHC in Hong Kong. However, affordability of PHC is not ideal. Indeed, narrowing the gap between availability and affordability is key to fully utilizing the capacity of the PHC system in Hong Kong. The private sector plays an important role in this, but the low coverage of medical insurance in outpatient services exacerbates the crowding of public PHC and underutilization of private PHC. We suggest diverting patients from public to private institutions through medical insurance, medical vouchers, or other ways, to relieve the pressure on the public health system and make full use of existing primary health care in Hong Kong.


Subject(s)
COVID-19 , Primary Health Care , Social Determinants of Health , Humans , Costs and Cost Analysis , COVID-19/epidemiology , Hong Kong/epidemiology , Spatial Analysis , Health Services Accessibility , Healthcare Disparities
5.
JAMA Netw Open ; 5(11): e2239860, 2022 Nov 01.
Article in English | MEDLINE | ID: covidwho-2093219

ABSTRACT

Importance: Housing insecurity-that is, difficulty with housing affordability and stability-is prevalent and results in increased risk for both homelessness and poor health. However, whether interventions that prevent housing insecurity upstream of homelessness improve health remains uncertain. Objective: To review evidence characterizing associations of primary prevention strategies for housing insecurity with adult physical health, mental health, health-related behaviors, health care use, and health care access. Evidence Review: Pairs of independent reviewers systematically searched PubMed, Web of Science, EconLit, and the Social Interventions Research and Evaluation Network for quantitative studies published from 2005 to 2021 that evaluated interventions intended to directly improve housing affordability and/or stability either by supporting at-risk households (targeted primary prevention) or by enhancing community-level housing supply and affordability in partnership with the health sector (structural primary prevention). Risk of bias was appraised using validated tools, and the evidence was synthesized using modified Grading of Recommendations Assessment, Development, and Evaluation criteria. Findings: A total of 26 articles describing 3 randomized trials and 20 observational studies (16 longitudinal designs and 4 cross-sectional quasi-waiting list control designs) were included. Existing interventions have focused primarily on mitigating housing insecurity for the most vulnerable individuals rather than preventing housing insecurity outright. Moderate-certainty evidence was found that eviction moratoriums were associated with reduced COVID-19 cases and deaths. Certainty of evidence was low or very low for health associations of other targeted primary prevention interventions, including emergency rent assistance, legal assistance with waiting list priority for public housing, long-term rent subsidies, and homeownership assistance. No studies evaluated health system-partnered structural primary prevention strategies. Conclusions and Relevance: This systematic review found mixed and mostly low-certainty evidence that interventions that promote housing affordability and stability were associated with improved adult health outcomes. Existing interventions may need to be paired with other efforts to address the structural determinants of health. As health care systems and insurers respond to increasing opportunities to invest in housing as a determinant of health, further research is needed to clarify where along the housing insecurity pathway interventions should focus for the most effective and equitable health impact.


Subject(s)
COVID-19 , Homeless Persons , Adult , Humans , Cross-Sectional Studies , COVID-19/epidemiology , COVID-19/prevention & control , Public Housing , Costs and Cost Analysis
6.
PLoS One ; 17(10): e0273667, 2022.
Article in English | MEDLINE | ID: covidwho-2089397

ABSTRACT

The magnitude of the cost of chronic pain has been a matter of concern in many countries worldwide. The high prevalence, the cost it implies for the health system, productivity, and absenteeism need to be addressed urgently. Studies have begun describing this problem in Chile, but there is still a debt in highlighting its importance and urgency on contributing to chronic pain financial coverage. This study objective is to estimate the expected cost of chronic pain and its related musculoskeletal diseases in the Chilean adult population. We conducted a mathematical decision model exercise, Markov Model, to estimate costs and consequences. Patients were classified into severe, moderate, and mild pain groups, restricted to five diseases: knee osteoarthritis, hip osteoarthritis, lower back pain, shoulder pain, and fibromyalgia. Data analysis considered a set of transition probabilities to estimate the total cost, sick leave payment, and productivity losses. Results show that the total annual cost for chronic pain in Chile is USD 943,413,490, corresponding an 80% to the five diseases studied. The highest costs are related to therapeutic management, followed by productivity losses and sick leave days. Low back pain and fibromyalgia are both the costlier chronic pain-related musculoskeletal diseases. We can conclude that the magnitude of the cost in our country's approach to chronic pain is related to increased productivity losses and sick leave payments. Incorporating actions to ensure access and financial coverage and new care strategies that reorganize care delivery to more integrated and comprehensive care could potentially impact costs in both patients and the health system. Finally, the impact of the COVID-19 pandemic will probably deepen even more this problem.


Subject(s)
COVID-19 , Chronic Pain , Fibromyalgia , Low Back Pain , Musculoskeletal Diseases , Adult , Humans , Chronic Pain/epidemiology , Chile/epidemiology , Fibromyalgia/epidemiology , Pandemics , Sick Leave , Low Back Pain/therapy , Musculoskeletal Diseases/epidemiology , Costs and Cost Analysis , Chronic Disease
7.
Ann Glob Health ; 88(1): 87, 2022.
Article in English | MEDLINE | ID: covidwho-2080770

ABSTRACT

Lack of transparency in vaccine pricing practices is a problem that has been under discussion for a long time. To tackle this, the World Health Assembly adopted the resolution Improving the transparency of markets for medicines, vaccines, and other health products in 2019. However, despite the appalling effects of the current pandemic and the unequal global distribution of vaccines, the 2019 resolution has not been included as a fundamental pillar in the global health response to COVID-19. Governments and public health agencies have provided public funding to pharmaceutical companies for research and development of new vaccines. Yet, information on pricing strategies and methodologies is still inaccessible. Furthermore, these companies are profiting from publicly funded research and development. But secrecy and opacity prevails in the pharmaceutical industry, affecting low and middle income countries. Situating the demand for transparency, accountability and fair pricing of pharmaceutical products as a global health justice issue, I suggest an independent global observatory for accountability and transparency in the pharmaceutical global market should be created to help international organizations, governments and civil society in their quest for affordable and safe vaccines and therapeutics.


Subject(s)
COVID-19 , Vaccines , Humans , COVID-19/prevention & control , Pandemics/prevention & control , Costs and Cost Analysis , Pharmaceutical Preparations
8.
BMJ Glob Health ; 7(9)2022 09.
Article in English | MEDLINE | ID: covidwho-2064141

ABSTRACT

INTRODUCTION: The scope of the challenge of overweight and obesity (OAO) has not been fully realised globally, in part because much of what is known about the economic impacts of OAO come from high-income countries (HICs) and are not readily comparable due to methodological differences. Our objective is to estimate the current and future national economic impacts of OAO globally. METHODS: We estimated economic impacts of OAO for 161 countries using a cost-of-illness approach. Direct and indirect costs of OAO between 2019 and 2060 were estimated from a societal perspective. We assessed the effect of two hypothetical scenarios of OAO prevalence projections. Country-specific data were sourced from published studies and global databases. RESULTS: The economic impact of OAO in 2019 is estimated at 2.19% of global gross domestic product (GDP) ranging on average from US$20 per capita in Africa to US$872 per capita in the Americas and from US$6 in low-income countries to US$1110 in HICs.If current trends continue, by 2060, the economic impacts from OAO are projected to rise to 3.29% of GDP globally. The biggest increase will be concentrated in lower resource countries with total economic costs increasing by fourfold between 2019 and 2060 in HICs, whereas they increase 12-25 times in low and middle-income countries. Reducing projected OAO prevalence by 5% annually from current trends or keeping it at 2019 levels will translate into average annual reductions of US$429 billion or US$2201 billion in costs, respectively, between 2020 and 2060 globally. CONCLUSION: This study provides novel evidence on the economic impact of OAO across different economic and geographic contexts. Our findings highlight the need for concerted and holistic action to address the global rise in OAO prevalence, to avert the significant risks of inaction and achieve the promise of whole-of-society gains in population well-being.


Subject(s)
Obesity , Overweight , Costs and Cost Analysis , Gross Domestic Product , Humans , Income , Obesity/epidemiology , Overweight/epidemiology
9.
PLoS One ; 17(4): e0266511, 2022.
Article in English | MEDLINE | ID: covidwho-2021658

ABSTRACT

This paper examines the effect of pandemic vaccination on asset prices in a simple asset pricing model à la Lucas 1978. In this model, asset prices depend on susceptible individuals' saving motives to insure against a reduction in labour income due to getting they get the virus. Hence distributing vaccine reduces precautionary saving motives and asset prices. This implies that reducing the income gap between susceptible and infected individuals, such as by cash handouts, eases the negative effect of vaccine supply on asset prices.


Subject(s)
Pandemics , Vaccination , Costs and Cost Analysis , Humans , Income , Pandemics/prevention & control
10.
Comput Intell Neurosci ; 2022: 5654271, 2022.
Article in English | MEDLINE | ID: covidwho-2020513

ABSTRACT

The study explores the risks and benefits of investors in e-commerce financing under the background of "double carbon" to maximize investors' interests and reduce investment losses. The Back Propagation Neural Network (BPNN) algorithm model of e-commerce enterprise financing based on the Capital Asset Pricing Model (CAPM) is mainly studied. First, according to the worldwide literature, the theoretical concept and principle of the CAPM are deeply studied and analyzed. Then, from the perspective of "double carbon," with the financing risk characteristics of listed companies responding to the "double carbon" policy as samples, the CAPM model of e-commerce financing under the BPNN algorithm is established. Next, the BPNN is used to input the financing samples of e-commerce enterprises and train the model. The verification experiment of the capital asset financing model of e-commerce enterprises is further conducted. The experimental results show that the model error is the smallest when the number of neurons in the hidden layer reaches about 20. Therefore, the number of neurons in the hidden layer of the model is set to 20. When the number of iterations in training reaches 3000, the financing risk model begins to show a convergence trend. Finally, it can be determined that the number of adaptive iterations of the model is 3000. When the learning rate is 0.03, the oscillation of the model is smaller and stabler, so the model learning rate is 0.03, and the final model error is only 9.96 × 10-8. Based on this, e-commerce enterprises can achieve the purpose using this model to adjust the coefficient in financing in the future. The results have certain reference significance for e-commerce financing risk assessment under a "double carbon" background.


Subject(s)
Commerce , Investments , Carbon , Costs and Cost Analysis , Neural Networks, Computer
11.
Med Care ; 60(9): 680-690, 2022 09 01.
Article in English | MEDLINE | ID: covidwho-2008676

ABSTRACT

BACKGROUND: In the US, Medicaid covers over 80 million Americans. Comparing access, quality, and costs across Medicaid programs can provide policymakers with much-needed information. As each Medicaid agency collects its member data, multiple barriers prevent sharing Medicaid data between states. To address this gap, the Medicaid Outcomes Distributed Research Network (MODRN) developed a research network of states to conduct rapid multi-state analyses without sharing individual-level data across states. OBJECTIVE: To describe goals, design, implementation, and evolution of MODRN to inform other research networks. METHODS: MODRN implemented a distributed research network using a common data model, with each state analyzing its own data; developed standardized measure specifications and statistical software code to conduct analyses; and disseminated findings to state and federal Medicaid policymakers. Based on feedback on Medicaid agency priorities, MODRN first sought to inform Medicaid policy to improve opioid use disorder treatment, particularly medication treatment. RESULTS: Since its 2017 inception, MODRN created 21 opioid use disorder quality measures in 13 states. MODRN modified its common data model over time to include additional elements. Initial barriers included harmonizing utilization data from Medicaid billing codes across states and adapting statistical methods to combine state-level results. The network demonstrated its utility and addressed barriers to conducting multi-state analyses of Medicaid administrative data. CONCLUSIONS: MODRN created a new, scalable, successful model for conducting policy research while complying with federal and state regulations to protect beneficiary health information. Platforms like MODRN may prove useful for emerging health challenges to facilitate evidence-based policymaking in Medicaid programs.


Subject(s)
Medicaid , Opioid-Related Disorders , Costs and Cost Analysis , Humans , United States
12.
Int J Health Plann Manage ; 37(6): 3028-3038, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2003596

ABSTRACT

OBJECTIVES: This article aims to analyse the impact of the pharmaceutical policy on the availability, accessibility and affordability of medicines to the Indian populace. The article delves into the shortcomings of the Drug Price Control Order 2013 and highlights its real-world implications. METHODS: Published literature in the form of scientific articles on the proposed reforms that took place in the pharmaceutical policy was reviewed. The study used the memorandums, laws and government decisions published by the Department of Pharmaceuticals, Ministry of Health and Family Welfare and National Pharmaceutical Pricing Authority|National Pharmaceutical Pricing Authorities. RESULTS: The pharmaceutical policy in India underwent several changes during 2013-2020 to enhance the affordability and accessibility of drugs. The stringent policy hampered innovation due to the lack of profitability to the Multinational Companies. Moreover, it was found that the impact of the price control order on the low-cost local generic manufacturers affected much of the country's price-sensitive population. CONCLUSION: The pharmaceutical policy of India needs to be amended to extend its benefit to its stakeholders. The government should shift its attention to improving the quality of drugs, increasing competition amongst manufacturers and enhancing the accessibility of medicines through state/centre sponsored initiatives.


Subject(s)
Drug Costs , Drug and Narcotic Control , Drugs, Generic , Costs and Cost Analysis , Social Welfare
14.
JAMA Health Forum ; 3(5): e221809, 2022 05 06.
Article in English | MEDLINE | ID: covidwho-1995512
16.
J Epidemiol Community Health ; 76(9): 833-838, 2022 09.
Article in English | MEDLINE | ID: covidwho-1993048

ABSTRACT

Recent crises have underscored the importance that housing has in sustaining good health and, equally, its potential to harm health. Considering this and building on Howden-Chapman's early glossary of housing and health and the WHO Housing and Health Guidelines, this paper introduces a range of housing and health-related terms, reflecting almost 20 years of development in the field. It defines key concepts currently used in research, policy and practice to describe housing in relation to health and health inequalities. Definitions are organised by three overarching aspects of housing: affordability (including housing affordability stress (HAS) and fuel poverty), suitability (including condition, accessibility and sustainable housing) and security (including precarious housing and homelessness). Each of these inter-related aspects of housing can be either protective of, or detrimental to, health. This glossary broadens our understanding of the relationship between housing and health to further promote interdisciplinarity and strengthen the nexus between these fields.


Subject(s)
Health Status , Housing , Costs and Cost Analysis , Homeless Persons , Housing/economics , Humans , Poverty
17.
BMJ Open ; 11(2): e038191, 2021 02 04.
Article in English | MEDLINE | ID: covidwho-1962174

ABSTRACT

INTRODUCTION: Offering primary healthcare through mobile medical units is an innovative way to reach the rural and the vulnerable population. With 292 mobile medical units, the Andhra Pradesh mobile medical unit (APMMU) programme is one of the largest health outreach programmes in rural India. However, India lacks reliable cost estimates for the health services delivered through mobile medical platforms. This study aims to estimate the unit cost of providing primary care services through mobile medical units in rural and tribal areas of Andhra Pradesh. METHOD AND ANALYSIS: Cost analysis of 12 mobile medical units will be undertaken. We will use the activity-based microcosting technique from the providers' perspective. A bottom-up approach will be used for cost estimation. Standardised tools will be used to collect data on activities and resources, and on the costs. Capital investments and recurrent costs will be measured and evaluated. Average unit costs, along with 95% CIs, will be reported. Sensitivity analysis will assess the cost estimate uncertainties and other cost assumptions. ETHICS AND DISSEMINATION: Piramal Swasthya Management Research Institute's ethics committee approved the study. The findings of the study will be disseminated through conference presentations, publications in peer-reviewed journals and advocacy with the national and state governments. This study will provide first-hand comprehensive cost estimates of provisioning primary healthcare services using mobile medical units in India.


Subject(s)
Mobile Health Units , Rural Population , Costs and Cost Analysis , Humans , India
18.
Lancet Planet Health ; 6(7): e565-e576, 2022 07.
Article in English | MEDLINE | ID: covidwho-1915214

ABSTRACT

BACKGROUND: The COVID-19 pandemic arrived at a time of faltering global poverty reduction and increasing levels of diet-related diseases, both of which have a strong link to poor outcomes for those with COVID-19. Governments responded to the pandemic by placing unprecedented restrictions on internal and external movements, which have resulted in an economic contraction. In response to the economic shock, G20 governments have committed to providing US$14 trillion stimuli to support economic recovery. We aimed to assess the impact of different COVID-19 recovery paths on human health, environmental sustainability, and food sustainability. METHODS: We used LandSyMM, a global gridded land use change model, to analyse the impact of recovery paths from COVID-19. The paths were illustrated by four scenarios that represent different pandemic severities (including a single or recurrent pandemic) and alternate modes of recovery, including a transition of food demand towards healthier diets that result in changes to the food system: (1) solidarity and celery, (2) nothing new, (3) fries and fragmentation, and (4) best laid plans. For each scenario, we modelled the economic shocks of the pandemic and the impact of policy measures to promote healthier diets in the years after the COVID-19 pandemic, including the supply of and demand for food, environmental outcomes, and human health outcomes. The four scenarios use established future population growth and economic development projections derived from the Shared Socioeconomic Pathways 2. We quantified the outcomes from more societally cooperative pandemic responses that result in reduced trade barriers and improved technological development against less cooperative responses. FINDINGS: Repeated pandemic shocks (the fries and fragmentation and best laid plans scenarios) reduce the ability of the lowest income countries to ensure food security. A post-pandemic recovery that includes dietary transition towards the consumption of less meat and more fruits and vegetables (the solidarity and celery scenario) could prevent 2583 premature deaths per million in 2060, whereas recovery paths that are focused on economic recovery (the fries and fragmentation scenario) could trigger an additional 778 deaths per million in 2060. The transition of dietary preferences towards healthier diets (the solidarity and celery scenario) also reduces nitrogen fertiliser use by 40 million tonnes and irrigation water by 400 km3 compared with no dietary change in 2060 (the nothing new scenario). Finally, the scenario with dietary transition increases the affordability of the average diet. INTERPRETATION: The economic impact of the COVID-19 pandemic is most visible in low-income countries, where a reduction in growth projections makes a greater difference to the affordability of a basic diet. A change in dietary preferences is most impactful in reducing mortality and the burden of disease when income levels are high. At lower income, a transition towards lower meat consumption reduces undernourishment and diet-related mortality. FUNDING: The Global Food Security's Resilience of the UK Food System Programme project, with support from the Biotechnology and Biological Sciences Research Council, Economic and Social Research Council, Natural Environment Research Council, and the Scottish Government.


Subject(s)
COVID-19 , COVID-19/epidemiology , Costs and Cost Analysis , Diet , Environmental Health , Humans , Pandemics/prevention & control , Vegetables
19.
BMJ Glob Health ; 7(Suppl 1)2022 05.
Article in English | MEDLINE | ID: covidwho-1896053

ABSTRACT

The COVID-19 pandemic had multiple adverse impacts on the health workforce that constrained their capacity to contain and combat the disease. To mitigate the impact of the pandemic on the Ghanaian health workforce, the government implemented a strategy to recruit qualified but unemployed health workers to fill staffing gaps and incentivise all public sector health workers. This paper estimated the cost of the new recruitments and incentives given to health workers and presented lessons for health workforce planning in future health emergencies towards health systems resilience. Between March and November 2020, 45 107 health workers were recruited, representing a 35% boost in the public sector health workforce capacity, and an increase in the recurrent public health sector wage bill by about GHS103 229 420 (US$17 798 176) per month, and about GHS1.24 billion (US$213.58 million) per annum. To incentivise the health workforce, the government announced a waiver of personal income taxes for all health workers in the public sector from April to December 2020 and offered a 50% additional allowance to some health workers. We estimate that the Government of Ghana spent about GH¢16.93 million (equivalent to US$2.92 million) monthly as COVID-19 response incentives, which translates into US$35 million by the end of 2020. Ghana invested considerably in health workforce recruitment and incentives to respond to the COVID-19 pandemic, resulting in an almost 37% increase in the public sector wage bill. Strengthening investments in decent employment, protection and safety for the health workforce using the various resources are helpful in addressing future pandemics.


Subject(s)
COVID-19 , Health Workforce , Costs and Cost Analysis , Ghana , Humans , Pandemics
20.
Tob Control ; 31(2): 235-240, 2022 03.
Article in English | MEDLINE | ID: covidwho-1891898

ABSTRACT

Optimising the taxation of tobacco products should be among the highest priorities for health and hence economic policy in every country. The WHO Technical Manual on Tobacco Tax Policy and Administration released in April 2021 provides invaluable advice, including 26 best practice recommendations on policy design, administrative efficiency and addressing industry tactics to circumvent tobacco tax increases. Introducing and increasing tobacco taxes is the most important tobacco control measure for any jurisdiction. The effects of simple tax structures, high tax levels, and frequent above-inflation increases in specific excise duties can be enhanced through strict controls on packaging (including pack size), product design, and discounting. However, even with such measures, tobacco companies can continue to undermine the effectiveness of tax policy by offering some products in their ranges at very low prices, as well as gradually and selectively increasing the prices of some but not all products after tax increases. This paper is aimed at policymakers in countries that have already adopted best practice tax policy. It explores the idea of wholesale price capping combined with retail licensing to address the problems of brand proliferation, dispersion of prices, cushioning and strategic under/overshifting of tax increases, thereby radically and sustainably increasing the effectiveness of tobacco tax policy while also raising additional tax revenue for governments by reducing industry profitability.


Subject(s)
Tobacco Industry , Tobacco Products , Commerce , Costs and Cost Analysis , Humans , Taxes , Tobacco
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