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Year : 2017  |  Volume : 13  |  Issue : 6  |  Page : 1075-1076

The feasibility of smoker's surcharge policy in tobacco control

1 Department of Public Health Dentistry, Annoor Dental College and Hospital, Muvattupuzha, Kerala, India
2 Department of Oral and Maxillofacial Surgery, Annoor Dental College and Hospital, Muvattupuzha, Kerala, India

Date of Web Publication13-Dec-2017

Correspondence Address:
Dr. Eby Aluckal
Department of Public Health Dentistry, Annoor Dental College, Muvattupuzha - 686 673, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0973-1482.199384

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How to cite this article:
Aluckal E, Lakshmanan S. The feasibility of smoker's surcharge policy in tobacco control. J Can Res Ther 2017;13:1075-6

How to cite this URL:
Aluckal E, Lakshmanan S. The feasibility of smoker's surcharge policy in tobacco control. J Can Res Ther [serial online] 2017 [cited 2020 Jul 6];13:1075-6. Available from: http://www.cancerjournal.net/text.asp?2017/13/6/1075/199384


The smoker's surcharge policy could be one of the interventions that would add up to the continued efforts in tobacco control. The rationale behind this article/policy can be mainly attributed to two things. The smokers incur more direct health-care costs than nonsmokers so that they should pay more into the system. Furthermore, having to pay a higher premium should motivate those who smoke to quit to save money. If smokers quit, they would get the benefit of reduced premiums and improved health while the system overall would see cost reductions because the ex-smoker is healthier.

The advantages also include a mainstream reduction in overall tobacco consumption and increased cessation among the employees with the greatest impact on young and poor. These punitive damages even give room for nonusers to abstain from initiation. More recently, as the information on the health consequences of tobacco use has expanded, tobacco smokers surcharge as well as increased taxes have been seen as an appropriate “user's fee” that covers the social and health costs of tobacco use and as a powerful tool for improving public health.[1] Employers implemented smoker surcharges with the goal of decreasing and shifting health-care costs for the company, especially for self-insured entities, and improving worker productivity through a healthier workforce. In India, raising cigarette taxes to Rs. 3691/1000 sticks from Rs. 659/1000 would increase tax revenues by Rs. 146.3 billion (US$ 3.1 billion), significantly reduce cigarette consumption, and prevent 3.4 million premature deaths in current and future cigarette smokers.[2] In US, the tobacco surcharges levied in health insurance exchanges during the 2014 coverage year varied greatly across the largest metropolitan areas in each state for 45-year-old tobacco users.[3]

However, there could be disadvantages too. First of all, charging tobacco users higher premiums stigmatizes and marginalizes this group, which not only undermines smoking cessation efforts but also can increase the likelihood that a person will continue to smoke. Secondly, by focusing on the idea that smokers choose to engage in unhealthy behaviors ignores all social factors that contribute to an individual beginning to smoke and make it difficult to quit. Finally, this policy issues an ultimatum to smokers to quit smoking or pay. This framing will threaten a smoker's freedom and will likely lead to psychological reactance, where the smoker becomes more intent on smoking to regain control. Ultimately charging smokers higher insurance premiums oversimplifies a very complicated behavior.[4] Hence, it can happen that this approach will not motivate smokers to quit and will fail to improve health outcomes and reduced health-care costs.

In a democratic developing country like India, implementing policies like smokers surcharge in the present scenario are questionable. More than 50% of the people still lack a health insurance which makes the policy not feasible for majority of population.[2] Even though smoking is completely banned in many public places and workplaces and even direct advertising through many forms of mass media is prohibited, strict enforcement of laws is yet to achieve. In my opinion, the primary objective should be to strictly enforce the tobacco control laws in the country. Smokers surcharge policy should be an adjunctive to these existing laws, and it should be accompanied by wellness program measures that will assist smokers to quit. Incentives should be provided by the government which will help in quitting the habit.

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Conflicts of interest

There are no conflicts of interest.

 > References Top

Deyton LR. FDA tobacco product regulations: a powerful tool for tobacco control. Public Health Rep 2011;126:167-9.  Back to cited text no. 1
John RM, Rao RK, Rao MG, Moore J, Deshpande RS, Sengupta J, et al. The Economics of Tobacco and Tobacco Taxation in India. Available from: http://www.global.tobaccofreekids.org/files/pdfs/en/India_tobacco_taxes_report_en.pdf. [Last accessed on 2015 May 12].  Back to cited text no. 2
Kaplan CM, Graetz I, Waters TM. Most exchange plans charge lower tobacco surcharges than allowed, but many tobacco users lack affordable coverage. Health Aff (Millwood) 2014;33:1466-73.  Back to cited text no. 3
Blacksher E. Carrots and sticks to promote healthy behaviors: a policy update. Hastings Cent Rep 2008;38:13-6.  Back to cited text no. 4


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