Public Support to Increase Cigarette
Price and Excise to Finance UHC
Hasbullah Thabrany dan Zahrina
Prevalence of Smoker
•
27% in 1995 to
36.5% in 2013
•
1.7% in 1995 to an
estimate of 6.7% in
2015 (Woman).
•
from 7.1% in 1995 to
20.5% in 2013 (Young
Smoker).
•
67% Man are smoker
•
217.400 death per
Year
Cigarette Production
and Excise
•
222.7 billion sticks in
2005 to 348 billion
sticks in 2015
•
IDR 32.6 Trillion in
2005 to IDR 139.6
Trillion
•
IDR 330 Trillions
spent for cigarette
•
Health Expenditure
IDR 71.1 Trillions
(MoF, 2015)
Deficite of JKN
•
JKN covered 65% of
the population
•
claim ratios of JKN of
111.5% in 2014 and
115.1% in 2015
•
Mobilize Fund from
cigarette excise and
earmarking the
revenue
Indonesia Philippines Vietnam Thailand Cambodia Lao DR Myanmar Malaysia Brunei Timor Leste Singapore 0
2 4 6 8 10 12 14
Perbandingan Harga Rokok di Negara ASEAN
Objective
•
This study explored the possibility the people’s support in
increasing cigarette prices and exice to meet financial shortage
of the JKN.
•
This polling conducted to explore cigarette consumption and
Method
Dec
2015
Jan
2016
Systematic Random Sampling
Phone Survey
by the interval of 20.000 of mobile phones numbers.
Result and Discussion
Respondent Characteristic
1. Male (61,0%) Female (39,0%)
2. Average age (32,9) in range 14-78 years old
3. Education majority graduated high school (50,7%)
4. Income of Respondent 1 million – 3 million (38,8%)
5. Occupation distribution; private sector (26,2%), non formal sector (20,9%),
Others (18,6%)
6. 56,5% are JKN Participant
7. 41,5% are smoker
8. Penerima Bantuan Iuran (PBI)
(13,2%), PBPU (66,9%), Private
Sector&Governmental Employee (19,9%)
•
The polling (65.9% males and 3.3% females) showed
41.3% respondents consume 1-2 pack cigarette per
day with spending of IDR 450 – 600 thousands per
month.
•
The proportion of non smoker who supported the
earmarking was hicher (83.4% ) compared to
smokers (75.9%).
•
The proportion of smokers who know that ciagarette
is harmful reached 96.8% but the large majority of
them had difficulties in quit smoking.
Merk Rokok
Jumlah
Persentase (%)
Sampoerna
189
45,5
Djarum
49
11,8
Gudang Garam
49
11,8
Bermacam-macam
8
1,9
Dunhill
16
3,8
Lain-Lain
34
8,2
Marlboro
35
8,4
Surya
35
8,4
“special insurance for smokers” or Sintax for JKN”
The highest ecxise as percent of retail prices is charged by Egypt with
73.3% of cigarette price goes to tax, followed by Thailand (66.59%) and
the Philippine (63.55%).
Local Tax : 10% of excise revenue for local government in Indonesia
Philippine has implemented sin tax with 80% of incremental revenue goes
to the National Health Insurance Program (PhilHealth), MDGs, and Health
Awareness program. (paul, 2016)
Public Support
Raised Cigarette Prices
Agreed
Disagree
.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
80.3
19.7
%
% Smoked
0
10
20
30
40
50
60
70
80
90
41.5
40.4
3.3
49.2
65.9
10.4
%
Cigarettes to Financing of the National Health Insurance, 2016
Disagreed (%)
Agreed (%)
p
Smoking
Non smokers
16.5
83.5
0.005
Smokers
24.0
76.0
JKN membership
Non member
20.7
79.3
0.989
Member
18.9
81.1
Types of JKN Membership
PBI
18.3
81.7
Employed (PPU)
17.9
82.1
0.797
Disagreed (%)
Agreed (%)
p
Aged
<30 years
15.1
84.9
30 – 40 years
22.9
77.1
0.012
41 – 50 years
24.8
75.2
0.013
51 – 60 years
23.4
76.6
0.120
> 60 years
23.5
76.5
0.423
Education
< 6 years
15.2
84.8
6 -12 years
19.4
80.6
0.193
> 12 years
21.3
78.7
0.167
Reported monthly inome (IDR)
<1 millions
20.8
79.2
1 – 3 millions
18.2
81.8
0.272
3 – 10 millions
19.1
80.9
0.345
Conclusion
•
The prevalence of cigarette smoking is high because of prices of cigarette
is relatively cheap and it will affect health financing.
•
41.3% respondents consume 1-2 pack of cigarettes per day wasting up to
IDR 600 thousands per month per smokers.
•
Almost all smokers (96.8%) know that ciagarette is harmful for their
health.
•
More than 72.3% of smokers said that they would stop smoking if the
price of cigarette is above IDR 50,000 per pack.
•
This study found that large majority (80%) of non smokers and 76%
smokers supported increasing cigarette prices and excise to supplement
financing for the JKN.
Recommendation
Further study to know how the legal and policy makers
support developing and implementing sin tax to finance JKN
Revising current Excise Law
Reference
• Help Tobacco Farmers and Tobacco industry workers to move to other crops and industry, Abou-Youssef,Hossam. 2002.The Egyptian Experience with Tobacco Earmarking. World Health Organization, Tobacco Taxation and Innovative Health Care Financing. 2012. World Health Organization Regional Officer For Southeast Asia
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• DJSN (Dewan Jaminan Sosial Nasional). Peta Jalan Jaminan Kesehatan Nasional. DJSN, Jakarta 2012.
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• Thabrany, Hasbullah. Jaminan Kesehatan Nasional. 2nd Edition, 3rd Printing, Rajagraphindo, Jakarta 2016
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