2017年-世界发展银行全球_Estimating_the_Distributional_Impact_of_Increasing_Taxes_on_Tobacco_Products_in_Armenia___Results_from_an_Extended_Cost-Effectiveness_Analysis_36页_1mb

报告摘要

Summary of "Estimating the Distributional Impact of Increasing Taxes on Tobacco Products in Armenia"

Core Content

This document presents the results of an extended cost-effectiveness analysis (ECEA) to evaluate the health, financial, and distributional impact of increasing tobacco excise taxes in Armenia. The study focuses on male smokers and uses a modeling approach to simulate the effects of a 45% price increase, equivalent to raising the excise tax rate to 75% of the retail price, as recommended by the World Health Organization (WHO). The analysis also includes stakeholder interviews to understand the political and social context of the tax increase proposal.

Main Findings

Health Impact

A 45% increase in cigarette prices would avert approximately 88,000 premature tobacco-related deaths.
The poorest quintile would account for half of the averted deaths, while the richest quintile would see only 10% of deaths averted.
The distribution of averted deaths aligns with quintile-specific smoking rates, with the poorest experiencing the highest reduction in mortality risk.

Financial Impact

The study estimates that US$ 63 million in out-of-pocket (OOP) expenditures related to tobacco-related disease treatment would be averted.
US$ 26 million in government savings would result from reduced treatment costs for those eligible for the government-funded basic benefits package (BBP).
22,000 poverty cases would be averted, defined as individuals falling below the national poverty line due to OOP medical expenditures for tobacco-related diseases.
33,000 cases of catastrophic health expenditures would also be averted, where individuals spend more than 10% of their consumption expenditure on tobacco-related treatment.

Distributional Benefits

The poorest and most vulnerable groups would benefit the most from the tax increase.
27% of poverty cases averted would be concentrated among the bottom 40% of the population.
The poorest quintile would experience higher price elasticity of demand for tobacco, leading to greater smoking cessation and thus more health and financial benefits.

Key Information

Policy Context

Armenia has one of the lowest tobacco tax rates in Europe and Central Asia.
The WHO recommends excise tax rates of 75% of the retail price for tobacco products.
Armenia ratified the FCTC in 2003, but has lagged behind in implementing tobacco control measures compared to other countries in the region.
The government has faced fiscal constraints and regional economic challenges, which have limited effective tobacco tax policies.

Methodology

The study used ECEA, which assesses health, financial, and distributional impacts of policy changes.
A Gamma distribution was used to simulate individual consumption patterns based on data from the 2014 Integrated Living Conditions Survey (ILCS).
Price elasticity of demand for tobacco was assumed to be -0.54, based on Kyrgyzstan data.
Quitting rates were calculated using a formula that incorporates price elasticity, participation elasticity, and smoking prevalence by age and wealth quintile.

Assumptions

The excise tax increase would be fully passed on to consumers.
Half of the price elasticity was attributed to participation elasticity.
Quitting is associated with health benefits and reduced healthcare costs, but substitution effects were not modeled.
The national poverty line was set at US$ 100 per month (41,698 AMD), and catastrophic health expenditures were defined as spending more than 10% of annual consumption on treatment.

Sensitivity Analyses

A flat price elasticity of -0.54 across all quintiles resulted in a similar total number of averted deaths (about 86,000) but a more uniform distribution.
Alternative poverty thresholds were tested, including a lower poverty line of US$ 79 per month and a food poverty line of US$ 56 per month.
Catastrophic health expenditure thresholds were also tested at 20% and 40% of individual consumption.

Stakeholder Insights

Stakeholder interviews were conducted with representatives from the Ministry of Health, international organizations, health professionals, local NGOs, and universities.
The interviews highlighted the political challenges of implementing tobacco tax increases, including opposition from the tobacco industry and concerns about regressivity (i.e., the tax burden falling more heavily on the poor).
The accession to the Eurasian Economic Union in 2015 and fiscal constraints created a window of opportunity for tobacco taxation to be placed on the policy agenda.
The qualitative analysis suggests that tobacco tax increases are politically sensitive, and the government's ability to implement them is influenced by economic conditions and public health priorities.

Conclusion

The ECEA results demonstrate that increasing tobacco taxes in Armenia would have large health and financial benefits, particularly for poor and vulnerable populations.
The pro-poor nature of the tax increase is supported by the distributional impact, with the bottom 40% of the population experiencing the largest share of benefits.
The study underscores the importance of considering distributional effects in policy decisions to ensure equity and poverty reduction in public health interventions.