Effect of the Burden Incurred by Tobacco-Defective Patients on Lost
Productivity
Putri Novia Permatasari
Faculty of Public Health, Universitas Airlangga, Mulyorejo, Surabaya, Indonesia
Keywords: Cigarette, Disability, Productivity, Burden, Motivation.
Abstract: The economic and health burden of the tobacco community is increasingly burdensome for low- and
middle-income countries, including Indonesia, compared to high-income countries. The total losses due to
cigarette consumption in 2013 reached Rp 378.75 trillion. The amount is derived from the loss of cigarette
purchases of Rp 138 trillion, the loss of productivity due to disease, disability and premature death at a
young age of Rp 235.4 trillion, and medical expenses due to tobacco-related illness of Rp. 5.35 trillion. The
purpose of this study was to determine the effect of the load burden caused by tobacco defect patients on
lost productivity. The method used is that of a literature study. This study found: Disability poses
psychological burdens related to motivation; people with disabilities have low motivation and have an effect
on decreasing productivity. Conclusion: a decrease in productivity that will increase the burden for others.
1 INTRODUCTION
Tobacco is known to have killed nearly 6 million
people per year, 5 million of whom are smokers and
former smokers (Indonesian Ministry of Health,
2010). The data shows that most smokers are in low-
and middle-income countries. Every year, the
number of smokers continues to increase and is
followed by smokers in the younger age group
(Direktorat PTPM, 2012). Indonesia is the third
largest cigarette consuming country in the world as
well as the fifth largest tobacco leaf producer in the
world (GATS, 2011). The Global Adult Tobacco
Survey results showed that cigarette consumption in
Indonesia in 2008 reached 225,000 billion cigarettes
(Muchijidin, 2009). The survey results also showed
that the number of tobacco users in the form of
cigarettes and other forms covers about 36% of the
total population of Indonesia. It is also known that
the largest cigarette users come from the lower
income levels of society. Not only is this from a low
economic point of view, but cigarette users also have
a low level of knowledge about the dangers of
smoking.
The increase in cigarette consumption each year
causes quite a lot of losses, not only in relation to
health but also in terms of the economy. One of the
major losses Indonesia has to endure is the growing
number of smokers at an increasingly young age
(GATS, 2011).
This will indirectly affect the
productivity of society, as well as the excessive
consumption of cigarettes causing disease to the
point of disability. According to the WHO,
cigarettes are known to be the main cause of the
high mortality rates of cardiovascular disease after
hypertension. According to Balitbangkes’ 2010 data,
cigarette expenditure from cigarettes reached Rp
245.41 trillion, including cigarette purchases from
the community of 138 trillion, loss of productivity
due to disability at a young age of Rp 105.3 trillion,
and medical expenses of Rp 2.11 trillion.
Hospitalisation costs due to smoking-related
illnesses amounted to Rp 1.85 trillion and smoking-
related outpatient costs amounted to Rp 0.26 trillion
(Kosen, 2012). Another disadvantage is the
disruption of productivity due to illness, disability,
and premature death at a young age to the cost of Rp
235.4 trillion. Judging from the loss of productivity,
especially in patients with disabilities, this study was
conducted to determine the impact of the burden on
the disabled patients due to the loss of productivity.
Permatasari, P.
Effect of the Burden Incurred by Tobacco-Defective Patients on Lost Productivity.
In Proceedings of the 4th Annual Meeting of the Indonesian Health Economics Association (INAHEA 2017), pages 135-138
ISBN: 978-989-758-335-3
Copyright © 2018 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
135

2 METHODS
This study used the descriptive research method
within a literature study design. A literature study is
a method of research done by collecting data from
various sources related to the topic of the research.
This research data comes from journals, and other
scientific articles which are then analysed further.
3 RESULTS
3.1 Disability and Burden of Disability
Disability in Kamus Besar Bahasa Indonesia
includes 1) deficiencies that cause the value or
quality to be not as good or to be less than perfect
(contained in body, mind, or morals); 2) blisters
[damage, stains] that cause the condition to be less
good (less perfect); 3) blemish, disgrace; 4) not
(less) perfect.
[8]
It can be inferred that disability is a
condition that manifests as a physical or mental
disorder that can interfere with a person when it
comes to performing their day-to-day activities
normally. Disability is one factor that can affect
one's productivity. People with disabilities will have
a lower productivity value compared to someone
who is not disabled.
Cigarettes are one of the risk factors of various
diseases that can cause disability, and also death.
The form of disability caused by cigarettes is mostly
in the form of physical disability. Disability caused
by cigarettes does not appear directly but as an effect
of the health problems that arise due to the
consumption of cigarettes in the long term.
According to the CDC (the Center for Disease
Control and Prevention), cigarettes harm organs in
the body. Smoking habits have been shown to be
associated with approximately 25 different types of
disease in various organs of the human body, such
as: mouth cancer, oesophageal cancer, cancer of the
pharynx and/or larynx, lung cancer, pancreatic
cancer, bladder cancer and vascular disease.
Smoking habits are known to also affect the eyes
and the reproductive system, so the risk of disability
in smokers will be higher.
Disease caused by cigarettes causes a person to
be unable to work and increases the cost to be paid
for treatment. When in a sick condition, the person
will lose productivity so that their needs become
unfulfilled. The disruption of health creates a lot of
burdens, including the burden of costs to be borne
by the patient due to medical costs to be incurred.
People with disabilities usually have a low economic
condition because they cannot work and this can be
a psychological burden for the sufferer.
Psychological burden has a huge impact on the
development of a person. A person can lose
motivation because they feel that they cannot
produce something to meet their needs and to
achieve their life goals.
Table 1: Total Medical Costs of Tobacco Related
Diseases, Indonesia 2013
Disease Total
cases
Cost per
episode
Total cost (Rp)
Low Birth
Weight
babies
216.050 6.185.362 1.336.347.460.100
Tumor of
Mouth and
Throat
6.670 3.733.141 24.900.050.470
Neoplasm
of
Esophagus
1.710 3.733.141 6.383.671.110
Neoplasm
of Stomach
10.440 3.733.141 38.973.992.040
Neoplasm
of Liver
13.400 3.733.141 50.024.089.400
Neoplasm
of Pancreas
2.910 3.733.141 10.863.440
Neoplasm
of Lung,
Bronchus
and Trachea
54.300 3.733.141 202.709.556.300
Neoplasm
of Cervix
28.940 3.733.141 108.037.100.540
Neoplasm
of Ovary
7.690 3.733.141 28.707.854.290
Neoplasm
of Gall
Bladder
10.160 3.733.141 1.106.933.657.050
Coronary
Heart
Disease
183.950 6.017.579 1.118.707.241.880
Cerebrovas
cular
Disease/Str
oke
144.780 7.726.946 1.118.707.241.880
Chronic
Obstructive
Pulmonary
Disease
248.310 4.551.951 1.294.165.188.810
Total 5.352.829.437.990
Source: www.cheps.or.id (CSO Workshop Minister of
Health RI: Cigarettes Prices : The Dilemma of
Development & Quality of Life, Jakarta 2016)
INAHEA 2017 - 4th Annual Meeting of the Indonesian Health Economics Association
136

3.2 Productivity
According to Kamus Besar Bahasa in Indonesia,
productivity is the ability to produce something, also
known as production power, or keproduktifan. It can
be concluded that it is due to the productivity of a
person to produce something to the maximum.
Productivity is a description of a person's health
condition; if the body is not in a healthy condition
then productivity cannot be achieved to the
maximum level. Disability is a condition that
prevents a person from becoming more productive.
If the disability is sufficiently severe, then one can
become entirely unproductive. People who are sick
from smoking are the ones who lose their
productivity. Cigarettes cause their working time to
be lost due to care, and not only that, but some of
them cannot return to work because of the organs
that cannot function again. Most sick smokers are
those in the productive age group, and so the biggest
disadvantage caused by cigarettes is the factor of
productivity.
Table 2: Total DALYs Loss due to Tobacco, by Disease
and Sex, Indonesia
Disease Total
DALYs
Loss
Male Female
Low Birth
Weight babies
2.274.200 1.249.520 1.024.680
Tumor of Mouth
and Throat
828.340 418.300 410.040
Neoplasm of
Esophagus
152.998 89.888 63.110
Neoplasm of
Stomach
65.500 34.990 30.510
Neoplasm of
Liver
148.360 75.260 73.090
Neoplasm of
Pancreas
49.560 30.100 19.460
Neoplasm of
Lung, Bronchus
and Trachea
403,16 383,62 19,54
Neoplasm of
Cervix
312.555 -- 312.555
Neoplasm of
Ovary
175.513 -- 175.513
Neoplasm of
Gall Bladder
218.511 129.013 89.497
Coronary Heart
Disease
204.349 127.612 76.736
Cerebrovascular
Disease/Stroke
847.740 777.085 783.031
Chronic 901.744 669.943 231.801
Disease Total
DALYs
Loss
Male Female
Obstructive
Pulmonary
Disease
Total 6,179,773 3,602,095 3,290,043
Source: www.cheps.or.id (CSO Workshop Ministry of
Health RI: Cigarettes Prices : The Dilemma of
Development & Quality of Life, Jakarta 2016)
3.3 The impact of the burden on
productivity
Disability is a condition that can cause a burden on
the sufferer. The burden can be psychological and
social. The psychological burden has a greater
impact on a person with disabilities because it may
affect their development and desire to achieve their
life goals. Because of the limited circumstances, a
person may lose their motivation to produce
something that is beneficial to himself and others.
Motivation is a state in which a person encourages
the desire of other individuals to perform certain
activities to achieve their goals. Motivation is an
important aspect of life, because motivation is an
impulse that is in a person before he or she does
something.
The psychological burden of a disabled patient
with regards to one's motivation to meet their needs
and to achieve their goals is difficult to do. Based on
the theory of the motivation process (Hasibuan), a
disabled person is inhibited in being able to do
something oriented to their life’s purpose as the
above cycle can not run properly due to the
disability. Therefore, people with disabilities have
lower motivation. Various studies show that
motivation has an effect on productivity, so low
motivation leads to decreased productivity in
patients with disabilities.
4 DISCUSSION
Based on table 1 the medical costs incurred for
tobacco-related illnesses have a substantial number
of cases with most diseases are chronic obstructive
pulmonary disease as many as 284,310 cases, while
the largest medical costs to be spent are for low birth
weight babies and chronic obstructive pulmonary
disease. Based on these data it is known that all
tobacco-related diseases cause a substantial burden
of medical expenses that prove that tobacco is at risk
for increasing poverty rates, especially for those who
Effect of the Burden Incurred by Tobacco-Defective Patients on Lost Productivity
137

have been ill because of tobacco consumption.
Based on table 2 total DALYs Loss due to tobacco is
high enough when viewed based on productivity
disease is the highest loss due to low birth weight
babies, whereas if viewed by sex the productivity
loss is greater in male gender. From the data it is
known that men lose more productivity, while most
men are workers. Especially those who cannot return
to work will be burdened with sickness or disability.
The psychological burden is a burden that must
be borne by the disabled patients. The psychological
burden is related to one's motivation to produce
something useful. The limitations experienced by
disabled patients make people with disabilities have
low motivation when it comes to meeting the needs
of life and achieving its goals. Low motivation is
directly related to productivity, and with low
motivation, disabled people will increasingly lose
productivity and cause greater economic losses due
to the burden that they transfer to others.
5 CONCLUSIONS
Tobacco-related illnesses cause considerable
medical costs to the sufferer and the high value of
productivity lost due to illness or disability.
Moreover disability poses also a psychological
burden associated with the motivation to meet their
needs. In disabled patients, these limitations are the
cause of low motivation and affect their
productivity, and productivity subsequently
decreases. The losses incurred due to the
productivity lost will be a burden for others.
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