State estimates of Medicaid expenditures attributable to cigarette smoking, fiscal year 1993.

OBJECTIVE To develop estimates of state Medicaid expenditures attributable to smoking for fiscal year 1993. METHODS The smoking-attributable fractions (SAFs) of state Medicaid expenditures were estimated using a national model that describes the relationship between smoking and medical expenditures, controlling for a variety of sociodemographic, economic, and behavioral factors. RESULTS In fiscal year 1993, the SAF for all states (all types of expenditures) was 14.4%, with a range from 8.6% in Washington DC to 19.2% in Nevada. On average, SAFs ranged from a low of 7.9% for home health services expenditures to 21.7% for hospital expenditures. An estimated total of $12.9 billion of fiscal year 1993 Medicaid expenditures was attributable to smoking. The relative error of this estimate was 40.3%. CONCLUSIONS Cigarette smoking accounts for a substantial portion of annual state Medicaid expenditures, with considerable variation among states. The range in expenditures among the states is due to differences in smoking prevalence, health status, other socioeconomic variables used in the model, and the level and scope of the Medicaid program.

[1]  S. Glantz,et al.  Tobacco litigation. Issues for public health and public policy. , 1997, JAMA.

[2]  C. Hoffman,et al.  Persons with chronic conditions. Their prevalence and costs. , 1996, JAMA.

[3]  T. Houston.  The Cigarette Papers , 1996 .

[4]  D. Rice,et al.  The cost of smoking in California, 1993 , 1995, Tobacco Control.

[5]  A. Skolnick.  Spate of lawsuits may finally find chink in tobacco industry's 'impenetrable armor'. , 1995, JAMA.

[6]  A. F. Williams,et al.  Annual economic costs attributable to cigarette smoking in Texas. , 1993, Texas medicine.

[7]  Oar,et al.  Respiratory health effects of passive smoking: lung cancer and other disorders , 1993 .

[8]  Sam.  Smoking-attributable mortality and years of potential life lost--United States, 1988. , 1991, MMWR. Morbidity and mortality weekly report.

[9]  R. Heidel,et al.  Reducing the Health Consequences of Smoking: 25 Years of Progress. A Report of the Surgeon General. , 1989 .

[10]  P L Remington,et al.  Design, characteristics, and usefulness of state-based behavioral risk factor surveillance: 1981-87. , 1988, Public health reports.

[11]  T. Hodgson,et al.  The economic costs of the health effects of smoking, 1984. , 1986, The Milbank quarterly.

[12]  G C Hogelin,et al.  The behavioral risk factor surveys: II. Design, methods, and estimates from combined state data. , 1985, American journal of preventive medicine.

[13]  P. Schmidt,et al.  Limited-Dependent and Qualitative Variables in Econometrics. , 1984 .

[14]  C. Morris,et al.  A Comparison of Alternative Models for the Demand for Medical Care , 1983 .

[15]  H. Humphrey.  Winning against big tobacco. Let's take the time to get it right. , 1997, Public health reports.

[16]  Smoking-attributable mortality and years of potential life lost--United States, 1984. , 1997, MMWR. Morbidity and mortality weekly report.

[17]  M. Moore,et al.  A new attack on smoking using an old-time remedy. , 1996, Public health reports.

[18]  D. Rice,et al.  Medical Care Expenditures Attributable to Cigarette Smoking , 1995 .

[19]  Medical-care expenditures attributable to cigarette smoking--United States, 1993. , 1994, MMWR. Morbidity and mortality weekly report.

[20]  E. Sekscenski,et al.  The National Nursing Home Survey: 1985 summary for the United States. , 1989, Vital and health statistics. Series 13, Data from the National Health Survey.

[21]  Education . Office on Smoking,et al.  The health consequences of involuntary smoking : a report of the Surgeon General , 1986 .

[22]  I. D. McIntosh.  Smoking and pregnancy: attributable risks and public health implications. , 1984, Canadian journal of public health = Revue canadienne de sante publique.

[23]  J. Heckman.  Sample selection bias as a specification error , 1979 .