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Smoking-attributable medical care costs in the USA


  • Miller, Vincent P.
  • Ernst, Carla
  • Collin, François


Medical care costs attributable to cigarette smoking are estimated using an econometric model of annual individual expenditures for four types of medical services: ambulatory, hospital, prescription drug, and other (which includes home health and durable medical equipment and excludes dental and mental health). The model follows the two-part specification of Duan et al. (1983). Estimation is carried out using the 1987 National Medical Expenditure Survey. Fitted values are used to calculate smoking-attributable fractions (SAFs) of expense by type of service and by age and gender category. The overall weighted average SAF is 6.54%. SAFs are generally largest for ambulatory and smallest for hospital expenses. They are larger for males and for the older age categories. The model is analyzed for heteroscedasticity and goodness of fit. Additional analysis using the National Health Interview Survey is conducted to test for the possible effect of not being able to include alcohol consumption in the primary model. A balanced repeated replication analysis is conducted to evaluate the variance of the SAFs. Variances are found to be acceptably small. An extension of the model to support evaluation of smoking-attributable costs for special populations such as individual states, and special insurance pools such as Medicaid recipients, is described. Results for the fifty states are presented. Conclusions and subjects for further research are discussed.

Suggested Citation

  • Miller, Vincent P. & Ernst, Carla & Collin, François, 1999. "Smoking-attributable medical care costs in the USA," Social Science & Medicine, Elsevier, vol. 48(3), pages 375-391, February.
  • Handle: RePEc:eee:socmed:v:48:y:1999:i:3:p:375-391

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    Cited by:

    1. Johnson, Elizabeth & Dominici, Francesca & Griswold, Michael & L. Zeger, Scott, 2003. "Disease cases and their medical costs attributable to smoking: an analysis of the national medical expenditure survey," Journal of Econometrics, Elsevier, vol. 112(1), pages 135-151, January.
    2. Cowan, Benjamin & Schwab, Benjamin, 2011. "The incidence of the healthcare costs of smoking," Journal of Health Economics, Elsevier, vol. 30(5), pages 1094-1102.
    3. Hahn, Ellen J DNS, RN & Rayens, Mary Kay PhD & Chaloupka, Frank J. PhD & Okoli, Chizimuzo T.C. BSN, RN & Yang, Jun MS, 2002. "Projected Smoking-Related Deaths Among U.S. Youth: A 2000 Update," University of California at San Francisco, Center for Tobacco Control Research and Education qt8j85j2ct, Center for Tobacco Control Research and Education, UC San Francisco.
    4. Lin, Tsui-Fang, 2008. "Modifiable health risk factors and medical expenditures - The case of Taiwan," Social Science & Medicine, Elsevier, vol. 67(11), pages 1727-1736, December.
    5. Arredondo, Armando & Parada, Irene & Carrillo, Carlos, 2002. "Financial consequences of changes in health care demands related to tobacco consumption in Mexico: information for policy makers," Health Policy, Elsevier, vol. 61(1), pages 43-55, July.
    6. Li-Shiun Chen & Ping Wang & Yao Yao, 2017. "Smoking, Health Capital, and Longevity: Evaluation of Personalized Cessation Treatments in a Lifecycle Model with Heterogeneous Agents," NBER Working Papers 23820, National Bureau of Economic Research, Inc.
    7. Sunday Azagba & Mesbah Sharaf & Christina Xiao Liu, 2013. "Disparities in health care utilization by smoking status in Canada," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 58(6), pages 913-925, December.


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