Vietnam is one of countries with the highest number of smokers in the world and the high smoking prevalence among men in the region. Although the real cigarette prices increased by around 4% during the 2010–2015 period, the prevalence of daily cigarette smoking among men decreased slightly from 31.3% to 30.7% during this period. This raises the question of whether cigarette consumption is sensitive to price. In this study, we estimated the effect of cigarette prices on smoking participation and tobacco expenditure in Vietnam. We found that a one-percent increase in the real cigarette price reduced the probability of cigarette smoking among males by 0.08 percentage points (95% CI from -0.06 to -0.10), equivalent to the price elasticity of the smoking prevalence at -0.26 (95% CI from -0.16% to -0.33%). Using this estimate, we predict that if the cigarette price is increased by 10%, the daily cigarette smoking prevalence among men would decrease from 30.7% to 29.9% and the number of male smokers would decline by around 270 thousand. Higher cigarette prices also reduced per capita tobacco expenditure of households. A one-percent increase in the cigarette price decreased per capita expenditure on tobacco consumption expenditure of households by 0.43 percent (the 95% CI from -0.029 to 0.822). This finding suggests that raising tobacco taxes and prices can be an effective measure to reduce tobacco use.

Introduction Poor people have remarkably lower health expenditure than rich people in Vietnam. According to the 2016 Vietnam Household Living Standard Survey, per capita health expenditure of the top quintile households is around 6 times higher than that of the bottom quintile households. Methods We analyze economic inequalities in health expenditure using the concentration index approach and data from the Vietnam Household Living Standard Surveys 2010-2016. Next, we use the instrumental-variable regression analysis to examine the crowding-out effect of tobacco expenditure on health expenditure. Finally, we use decomposition analysis to explore whether economic inequality in tobacco expenditure is associated with an economic inequality in health expenditure. Results We find a crowding-out effect of tobacco expenditure on health expenditure of households. The share of health expenditure of households with tobacco spending is 0.78% lower than that of households without tobacco spending. It is estimated that a one-VND increase in tobacco expenditure results in a 0.18 VND (95% CI: −0.30 to −0.06) decrease in health expenditure. There is a negative association between economic inequality in tobacco expenditure and economic inequality in health expenditure. This means that if the poor consume less tobacco, their expenditure on health can be increased, resulting in a decrease in inequality in health expenditure. Conclusions Findings from this study suggest that reducing tobacco expenditure could improve health care of the poor and reduce inequality in health care in Vietnam. Our study recommends that the government continuously increase the tobacco tax in order to effectively reduce tobacco consumption. IMPLICATIONS Empirical studies show mixed results on the effect of tobacco expenditure on health expenditure. We find a crowding-out effect of tobacco expenditure on health expenditure of poor households in Vietnam. It implies that if the poor reduce their expenditure on tobacco, economic inequality in health expenditure can be reduced. Our findings suggest that reducing tobacco consumption of poor households can increase their health expenditure, therefore decreasing inequality in health expenditure. Different policies to reduce tobacco consumption such as tobacco taxation, smoke-free areas and tobacco advertisement bans should be strengthened.

BackgroundVietnam is a country with very high smoking rates among men. According to a Global Adult Tobacco Survey (GATS) conducted in 2015, the daily smoking prevalence among Vietnamese men was 39%.MethodsWe used data from the 2010 and 2015 Vietnamese GATSs and cigarette price data from General Statistics Office of Vietnam. Since smoking prevalence is low among women, we only considered men. Using discrete-time hazard models, we estimated the effect of cigarette prices on smoking onset and cessation. Sensitivity analyses are conducted using different model specifications.ResultsWe find that higher cigarette prices reduce the probability of smoking onset. A 1% increase in the cigarette price reduces the hazard of smoking onset by 1.2% (95% CI −2.12% to −0.28%). This suggests that increases in tobacco taxation, which translate to price increases, can reduce smoking onset. We did not find evidence that cigarette prices impact smoking cessation among men in Vietnam.ConclusionVietnam should continue to increase excise taxes on tobacco products to reduce smoking onset. Since smokers are resilient to excise tax increases, other tobacco control policies, such as smoke-free areas and tobacco advertisement bans, should be better enforced to encourage people to quit. Other policies not yet implemented, such as plain packaging of tobacco products, may also encourage smokers to quit.

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