Penner M, Penner S
Department of Public Management, College of Professional Studies, University of San Francisco 94117-1080.
J Occup Med. 1990 Jun;32(6):521-3. doi: 10.1097/00043764-199006000-00008.
Health insurance costs from tobacco have been estimated from tobacco's contribution to annual or lifetime costs for heart disease, emphysema, and selected cancers. Because health plans seldom identify tobacco users, there are few published studies that compare users with nonusers. This study gathered data on paid claims from a large group's indemnity plan (4108 users, 16,723 nonusers) from Jan 1 to Nov 30, 1988. Tobacco users had more admissions per 1000 (124 v 76), days per 1000 (800 v 381), a longer average length of stay (6.47 v 5.03 days), higher average outpatient payments ($122 v $75), and higher average insured payments ($1,145 v $762). Tobacco use is correlated with other high-risk behaviors; thus, cost and utilization differences are not solely due to its effects. Nevertheless, tobacco users add to employer costs for health insurance as well as for absenteeism, workers' compensation, and life insurance. Employers may use these data to reduce costs by not hiring tobacco users, adding surcharges for their health insurance, and strongly encouraging cessation. Issues of equity are discussed in terms of coerciveness and intrusiveness.
烟草导致的医疗保险费用是根据烟草对心脏病、肺气肿和特定癌症的年度或终身费用的影响来估算的。由于健康保险计划很少能识别出烟草使用者，因此很少有已发表的研究对使用者和非使用者进行比较。本研究收集了1988年1月1日至11月30日期间一个大型团体的赔偿计划（4108名使用者，16723名非使用者）的付费理赔数据。每1000名烟草使用者的住院次数更多（124次对76次），每1000天的住院天数更多（800天对381天），平均住院时间更长（6.47天对5.03天），平均门诊费用更高（122美元对75美元），平均保险赔付更高（1145美元对762美元）。吸烟与其他高危行为相关；因此，成本和使用差异并不完全是由吸烟的影响造成的。尽管如此，烟草使用者增加了雇主在医疗保险、旷工、工伤赔偿和人寿保险方面的成本。雇主可以利用这些数据，通过不雇佣烟草使用者、对他们的医疗保险加收附加费以及大力鼓励戒烟来降低成本。本文从强制性和侵扰性方面讨论了公平问题。
