The Impact of Purchasing Pattern after Increasing Cigarette Taxes to
National Health Status and Health Insurance in Indonesia
Dini Rahma Yanti
Faculty of Public Health, Universitas Airlangga, Mulyorejo, Surabaya, Indonesia
Keywords: Tobacco smoking, Purchasing pattern, Cigarette taxes, Health status, Health insurance.
Abstract: Tobacco smoking had been an international health issue for many decades. Tobacco kills more than 7
million people each year and more than 1 billion smokers live in low- and middle-income countries.
Indonesian has been known as one of the country with lowest cigarette taxes. It leads to a significant decline
in health status and an increase the burden of national health insurance. The discourse to raise cigarette
taxes in September 2017 later will be an effective solution to reduce the number of smokers in Indonesia
and pressing down the purchasing pattern. Using a literature review of several related research and, the
result shows that purchasing pattern after increasing cigarette in another country have an impact to national
health status and health insurance. Therefore, it is necessary to have a further analysis about the
implementation in Indonesia.
1 INTRODUCTION
Tobacco had been used in the early America and
significantly increases its popularity by the arrival of
Spain to America which also introduced tobacco to
the Europeans. The cigarettes shaped tobacco was
becoming popularized in the new world by the
industrial revolution era (Heckewelder, 2006). A
cigarette, or “cigaret”, is a small cylinder tobacco
leaves which had finely cut and rolled in thin paper
for smoking. Along with the spread, health problems
related to the use of cigarettes began to appear
(Wigand, 2006).
The literature shows that tobacco kills more than
half of its user. Tobacco also kills more than 7
million people each year which more than 6 million
of those deaths are the result of direct tobacco use.
Moreover, more than 1 billion smokers in the world
(80%) live in low and middle-income countries
(World Health Organization, 2017). Thus it can be
stated that cigarettes have caused a decline in the
quality of human health in general. While a
deterioration in the quality of health may impose
additional burdens on the financing of national
health insurance. Accordingly, WHO FCTC
(Framework Convention on Tobacco Control) stated
that Tobacco use caused serious disability and
significantly increases the risk of a number of
additional diseases not immediately linked to it such
as tuberculosis (Tobacco-Free Kids, 2017).
However, it is the wider economic and development
impacts of tobacco that must be better understood.
In Indonesia, there are approximately 57 million
active smokers, consist of around 63% men and 5%
women. Thus make Indonesia ranked third in the
world for total number of smokers. (Tobacco-Free
Kids, 2017). Indonesia also known as one of the
countries with low cigarettes taxes. Increasing
cigarette tax is expected to suppress the purchasing
pattern of Indonesian as a solution to improve health
quality and ease the burden of national insurance.
2 METHODS
In this research, a systematic literature review for
many researches around the world including
Indonesia will be used, using a keyword cigarettes
purchasing pattern, relation between smoking, health
status, health cost and national health insurance.
The hypothesis is that there is correlation between
cigarette’s purchasing pattern after increasing
cigarette taxes to national health status and national
insurance.
Yanti, D.
The Impact of Purchasing Pattern after Increasing Cigarette Taxes to National Health Status and Health Insurance in Indonesia.
In Proceedings of the 4th Annual Meeting of the Indonesian Health Economics Association (INAHEA 2017), pages 61-64
ISBN: 978-989-758-335-3
Copyright © 2018 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
61

3 RESULTS
Result compiled from some journal researches
related to smoking behaviour, tobacco tax, health
status, and health insurance. Table 1 is the research
compilation related to cigarettes purchasing pattern.
Table 1: Cigarettes Purchasing Pattern Research
Journal Tittle
Writer and
Published
Date
Research
Method
Result of the Studies
Purchasing Patterns and Smoking
Behaviours After a Large Tobacco Tax
Increase: A Study of Chinese
Americans Living in New York City
Jennifer
Cantrell,
MPA, DrPH
Candidate,
March 2008
Cross-
sectional
study
a. 54.7% of respondents is in at least one
tax-avoidance strategy.
b. Among the 216 smokers, changes in
smoking behaviour in response to the tax
increase is re
p
orted.
Effects of Tobacco Taxation and
Pricing on Smoking Behaviour in High
Risk Populations (US) : A Knowledge
Synthesis
Pearl Bader,
October 2011
Systematic
Review,
Expert panel
Raising cigarette prices through increased
taxes is a more effective tobacco control
policy measure for reducing smoking
behaviour among youth, young adults, and
persons of low socioeconomic status,
com
p
ared to the
g
eneral
p
o
p
ulation.
Cigarette Purchasing Patterns Among
New York Smokers
Kevin Davis,
March 2006
Analytic
Method
Smokers in New York are sensitive to
higher cigarette prices and reduce the
number of cigarettes they smoke when
p
rices are increased.
Raising Cigarette Taxes Reduces
Smoking, Especially Among Kids
Ann Boonn,
January 2017
Systematic
Review
Cigarette consumption from 1970 to 2015
show that there is a strong correlation
between increasing prices and decreasing
consum
p
tion.
Analysis of Product Influence, Price
And Promotion To The Result of
Purchase of Surya Cigarette (Study At
Universitas Kanjuruhan Malang
Indonesia
)
Dadang Tru
Nugroho,
2015
Multiple
Linear
Regression
Analysis
The product variables, prices and
promotions simultaneously affect the
buying decision.
Cigarette Taxes and Smoking
Kevin
Callison,
2014
Synthetic
control
approach
There is negative, small and significant
association between cigarette taxes and
either smoking participation or the average
number of daily cigarettes.
Promotion, Distribution, Price
Influence Against Purchase Decision
of Surreal Promild Cigarette : Study in
Indonesia
Jilly
Bernadette
Mandey, 2013
Multiple
Linear
Regression
Analysis
Promotion, distribution, and price have a
significant effect on purchasing decision,
while price has no significant effect to
purchasing decision.
A view study shows that there is correlation
between cigarette prices and cigarette taxes with the
purchasing pattern of cigarette. Therefor there is
some research showing the opposite result of those
hypotheses
.
Table 2: Smoking and Health Status Research
Journal Tittle
Writer and
Date
Publishe
d
Research
Method
Result of the Studies
Self-Rated Health Status and Smoking
Nouran
Mahmoud,
2011
Bivariate
Analysis
There is significant relationship between
self-rated health status and the exposure
variables smokin
g
status.
Public Health Implications of Raising
the Minimum Age of Legal Access to
Tobacco Products
Bonnie et al.,
2015
Literature
Review
Tobacco use is associated caused mortality
with several cases such as lung infections,
coronar
y
heart disease, chronic obstructive
INAHEA 2017 - 4th Annual Meeting of the Indonesian Health Economics Association
62

Journal Tittle
Writer and
Date
Publishe
d
Research
Method
Result of the Studies
p
ulmonar
y
disease and a variet
y
of cancers.
The result of the studies shows that there is a
correlation or relationship between smoking
cigarette and decreasing heath status. Thus, high
cigarette purchasing pattern will affecting smokers
heath status.
Table 3: Smoking and National Health Insurance Research
Literature Tittle Published Result of the Studies
Tobacco Cost to
Economy
WHO, 2013
Tobacco’s cost includes social, welfare and health care spending, higher
numbers of accidents and higher insurance premiums.
Info BPJS Kesehatan* ;
Dues Adjustment
BPJS, 2015
Raise cigarette taxes and allocate a portion for health financing the
community can increase the budget allocation for national health insurance.
* BPJS Kesehatan is Indonesian Health Insurance Program
The result of the studies shows that there is a
correlation or relationship between smoking
cigarette and burdening national health insurance.
Thus, low cigarette purchasing pattern and high
cigarette taxes will ease the burden.
4 DISCUSSION
Implementation of non-smoking areas in Indonesia,
especially in Surabaya has not fully run optimally as
a whole. There needs to be firm action in the form of
sanctions for those who violate the Regulation of No
Smoking Area. Related parties may create
promotions or enforce the latest model of tobacco
control on Non-Smoking Areas (KTR). Most
Indonesians love the latest information with the
latest. This will minimize the citizens of Indonesia
who consume cigarettes, They gradually follow the
process will understand that health is more important
and more apply the good tobacco control for us
together and encourage the movement of society to
create Indonesia free from smoke.
4.1 Purchasing Pattern after Increasing
Cigarettes Taxes
Based on the results of literature review studies
obtained some research results indicate that there is
a significant influence between price increases or
cigarette taxes with a decrease in purchases pattern
and smoking habits in the society (Bader et al.,
2011; Davis et al., 2006; Boonn, 2017; Nugroho et
al., 2015). However, view amount of research
proving that the correlation between the two
variables is weak and insignificant (Callison &
Kaestner, 2014; Mandey, 2013). This may be due to
differences in the characteristics of respondents,
research area and socio-economic levels. So it can
be concluded that increasing cigarette tax in one of
effective effort to pressing down cigarettes
purchasing pattern in many region including
Indonesia.
4.2 Smoking and Health Status
Some previous research results have illustrated the
existence of a negative influence between cigarette
consumption and health status, both self-health
status and national health status (Mahmoud, 2011;
Bonnie et al., 2015). Cigarette illnesses such as
coronary heart disease, lung infections, and chronic
obstructive pulmonary disease have become one of
the leading causes of death in the world. Both for
active smokers and second-hand smokers, health
problems that appear because the toxic substances in
cigarettes are endanger. Hopefully, by decreasing
cigarettes purchasing behaviour after increasing
cigarettes taxes will reduce the risk of smoking-
related diseases in Indonesia
4.3 Smoking and National Health
Insurance
Implementation of the national health insurance
system in the form of “BPJS Kesehatan” in
Indonesia is expected to provide maximum service
for the entire community. However, there is some
The Impact of Purchasing Pattern after Increasing Cigarette Taxes to National Health Status and Health Insurance in Indonesia
63

obstacles in the implementation of Indonesia's
national health system, one of them is the
operational BPJS Health in 2014 which experienced
an imbalance or mismatch in the ratio of claims, due
to the outgoing financing greater than the
contribution of the incoming premiums up to
103.88% (BPJS Kesehatan, 2015). Therefore it can
be predicted that lower cigarettes purchasing pattern
will be able to pressing down the cost-economy
which related to smoking-related disease. Besides,
the higher cigarette tax might be increase the budget
allocation to the national health system so as to
improve the quality of health service and maintain
the health insurance program continuity in Indonesia
5 CONCLUSIONS
Based on the results of several literature reviews
related cigarettes purchasing pattern can be
concluded that the increase in cigarette taxes may
have an impact on the decline of cigarette
purchasing pattern, so that will be one of the
effective solution to increase the national health
status and reduction the burden of national health
insurance in Indonesian.
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