Measuring the harm of sugar sweetened beverages and internalities associated with it.

Introduction: Obesity, which is partly driven by the consumption of sugar-sweetened beverages (SSBs), significantly increases the risk of type-2 diabetes and cardiovascular diseases, leading to substantial health and economic burdens. Methods: This study aims to quantify the monetary value of health harms caused by SSB consumption, along with the associated internalities, through a contingent valuation survey. The results are crucial for determining the socially optimal tax rate. Results: We surveyed 293 residents of Wellington, New Zealand, to assess their willingness to pay (WTP) for reductions in the risks of diabetes, stroke, and heart disease associated with SSB intake. Logistic regression analysis revealed the marginal WTP for a 1% risk reduction in diabetes, stroke, and heart disease to be NZ$404.86, NZ$809.04, and NZ$1,236.84, respectively. Based on these values, we estimate the marginal harm from SSB consumption to be approximately NZ$17.37 per liter in New Zealand, with internalities amounting to NZ$6.43 per liter, suggesting an optimal tax rate of NZ$6.49 per liter. Discussion: Implementing such a tax is feasible and would likely double or triple the price of SSBs in New Zealand.

Health Care-Related Savings Accounts, Health Care Expenditures, and Tax Expenditures.

Importance: Approximately 30% of US families with employer-sponsored health insurance, disproportionately drawn from high-income groups, benefit from flexible spending accounts (FSAs) or health savings accounts (HSAs). The combined association through both out-of-pocket spending and premiums of these tax-favored accounts with health care expenditures and tax expenditures remain uncertain. Objective: To compare the health care and health-related tax expenditures among families holding FSAs, HSAs, or neither type of account. Design, Setting, and Participants: This cross-sectional study used family-level data from the Medical Expenditure Panel Survey from January 1, 2011, to December 31, 2019, and conducted regression models, controlling for demographic and socioeconomic characteristics, chronic conditions, prior health care expenditures, and marginal tax rates to analyze how holding tax-favored accounts is associated with families' health care spending and tax expenditures. The sample was restricted to families included in the survey for 2 years, with no members 65 years or older, and with at least 1 policyholder covered (only) by full-year employer-sponsored insurance. Data were analyzed from December 1, 2023, to April 30, 2024. Exposures: Holding FSAs or HSAs. Main Outcomes and Measures: Out-of-pocket and insurance-paid health expenditures overall and by service were measured. Health-related tax expenditures were based on tax-excluded insurance premiums and tax-sheltered out-of-pocket expenses. Results: Of the 17 038 families included in the study sample, 2628 held FSAs (weighted 17%) and 1845 (weighted 13%) held HSAs. In regression-adjusted models, families with FSAs spent a mean of 20% or $2033 (95% CI, $789-$3276) more on health care annually than non-account holding families, largely due to increased insurer-paid expenses. Families with HSAs spent a mean of 44% or $697 (95% CI, $521-$873) more on out-of-pocket expenditures and had insignificantly higher insurance-paid expenditures than families without accounts, resulting in overall expenditures comparable to those of non-account holders. The additional tax expenditures associated with FSAs were a mean of $1306 (95% CI, $536-$2076) annually per family. Both types of funds were associated with significant increases in tax expenditures from additional office-based visits ($445 [95% CI, $244-$645] for FSAs and $174 [95% CI, $11-$336] for HSAs), outpatient visits ($330 [95% CI, $132-$528] for FSAs and $250 [95% CI, $15-$485] for HSAs), dental visits ($180 [95% CI, $126-$233] for FSAs and $165 [95% CI, $104-$226] for HSAs), and vision care ($36 [95% CI, $28-$45] for FSAs and $52 [95% CI, $40-$64] for HSAs). Conclusions and Relevance: Participation in FSAs is associated with higher health care expenditures and tax expenditures, while HSAs are not associated with reduced expenditures. Tax policy could be better targeted to enhance insurance coverage and health care accessibility.

Public welfare donation, rent sharing, and income gap within enterprises.

This study utilizes data from A-share listed companies between 2011 and 2020 to empirically investigate the impact and mechanism of public welfare donations on the internal income gap of enterprises. The research findings indicate that public welfare donations significantly increase the per capita salary of management, while their impact on the per capita salary of ordinary employees is not significant, thus leading to an expansion of the internal income gap within enterprises. The results from mechanism testing reveal that the income tax benefits resulting from charitable donations and the rise in corporate operating income have contributed to an increase in excess rent shared by enterprises and employees. Due to a stronger bargaining power, management shares more excess rents, thereby widening the income gap within the enterprise. Heterogeneity analysis demonstrates that public welfare donations have a greater impact on the internal income gap of non-state-owned enterprises; however, limiting executive compensation and enhancing employees' bargaining power can mitigate this widening effect caused by public welfare donations on enterprise's internal income gap. The research value of this study is threefold. Firstly, there is a scarcity of studies on the impact of public welfare donations on the income gap within enterprises, and this study contributes to enriching the research in this area. Secondly, this paper examines the effect of tax incentives for public welfare donations on the internal income gap of enterprises, thereby deepening the research on the impact of tax reduction and fee reduction, as well as expanding our understanding of corporate income tax preferential policies. Thirdly, it offers insights into improving enterprise compensation systems and enhancing corporate governance. Senior executives can potentially allocate more excess rent through their strong bargaining power. If their compensation remains unrestricted, it may lead to a widening internal income gap and negatively affect company operational efficiency.

Can revenue collection for public funding in health care be progressive? An assessment of 29 Countries.

Most research on health care equity focuses on accessing services, with less attention given to how revenue is collected to pay for a country's health care bill. This article examines the progressivity of revenue collection among publicly funded sources: income taxes, social insurance (often in the form of payroll) taxes, and consumption taxes (e.g., value-added taxes). We develop methodology to derive a qualitative index that rates each of 29 high-income countries as to its progressivity or regressivity for each of the three sources of revenue. A variety of data sources are employed, some from secondary data sources and other from country representatives of the Health Systems and Policy Monitor of the European Observatory on Health Systems and Policies. We found that countries with more progressive income tax systems used more income-based tax brackets and had larger differences in marginal tax rates between the brackets. The more progressive social insurance revenue collection systems did not have an upper income cap and exempted poorer persons or reduced their contributions. The only pattern regarding consumption taxes was that countries that exhibited the fewest overall income inequalities tended to have least regressive consumption tax policies. The article also provides several examples from the sample of countries on ways to make public revenue financing of health care more progressive.

Evaluation of Tobacco Tax Funding to Eradicate Illicit Cigarettes in Indonesia: A Qualitative Approach.

OBJECTIVES: The illicit cigarette trade endangers public health because it increases access to cheaper tobacco products, hence fueling the tobacco epidemic and undermining tobacco control policies. The objective of this study was to evaluate the execution of an illicit cigarette eradication program under the jurisdiction of the local government in Indonesia. We sought to provide insights into the effectiveness of current policies and their impact on the illicit cigarette trade in line with the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) protocol to eliminate illicit trade in tobacco products. METHODS: We conducted semistructured interviews with key policy-makers and semistructured FGDs with consumers and small- to medium-scale cigarette manufacturers at the district level. We indentified Pasuruan and Kudus as the districts or cities with the highest proportion of DBH CHT, and Jepara and Malang as a district with a highest illicit cigarette incident. We used reflective thematic analysis to identify the important opportunities and challenges facing illicit cigarette eradication programs in the three districts. RESULTS: We identified four opportunities and four challenges related to illicit cigarette eradication program implementation under the local government. The opportunities for illicit cigarette eradication lie in strong central government regulatory and multisectoral authority support, consumer awareness, and local governments' commitment to tobacco supply chain control. The key challenges facing illicit cigarette eradication include ineffective public dissemination programs, rapidly changing regulatory designs, consumers' preferences for illicit products, and a lack of industrial involvement in tobacco supply chain control programs. CONCLUSION: In addition to significant budget allocation and increasing consumer awareness, local programs to eradicate illicit cigarette production require considerable evaluation to rethink the program's design and external stakeholders' engagement within the local government's scope.

Do regional tax incentive policies improve productivity?

The difficulty in transforming old industrial areas constitutes a significant factor contributing to regional development imbalances. Can regional tax incentives, as a crucial component of regional policies, polish the "rust belt" regions? This study leverages the inaugural Value-Added Tax (VAT) reform in China as an opportunity to explore the potential of regional tax incentives in achieving sustainable development in traditional industrial areas. Drawing upon a comprehensive industrial enterprise database, we employ a Propensity Score Matching-Difference in Differences (PSM-DID) approach to examine the efficacy of these tax incentives. Our findings reveal that: (1) Regional tax incentives primarily enhance firms productivity by stimulating investment in enterprises, yet they do not contribute to improved investment efficiency or spur innovation within firms. (2) Regional tax incentives have alleviated financing constraints for enterprises in old industrial bases, significantly enhancing the Total Factor Productivity (TFP) of firms with higher financing constraints. This policy has had an even stronger impact on improving the TFP of state-owned and monopolistic enterprises. (3) Regional tax incentives have impeded productivity growth by preventing the exit of low-efficiency firms and the entry of high-efficiency ones. These incentives also increased the likelihood of "zombie firms" forming and failed to promote endogenous economic growth in the Northeast region. Additionally, they have distorted the allocation of resources towards capital and technology-intensive industries in that area. In China's old industrial bases, regional tax incentives should be coordinated with market-oriented reforms; these regional tax incentive policies should also be further enriched.

Estimated reduction in obesity prevalence and costs of a 20% and 30% ad valorem excise tax to sugar-sweetened beverages in Brazil: A modeling study.

BACKGROUND: The consumption of sugar-sweetened beverages (SSBs) is associated with obesity, metabolic diseases, and incremental healthcare costs. Given their health consequences, the World Health Organization (WHO) recommended that countries implement taxes on SSB. Over the last 10 years, obesity prevalence has almost doubled in Brazil, yet, in 2016, the Brazilian government cut the existing federal SSB taxes to their current 4%. Since 2022, a bill to impose a 20% tax on SSB has been under discussion in the Brazilian Senate. To simulate the potential impact of increasing taxes on SSB in Brazil, we aimed to estimate the price-elasticity of SSB and the potential impact of a new 20% or 30% excise SSB tax on consumption, obesity prevalence, and cost savings. METHODS AND FINDINGS: Using household purchases data from the Brazilian Household Budget Survey (POF) from 2017/2018, we estimated constant elasticity regressions. We used a log-log specification by income level for all beverage categories: (1) sugar-sweetened beverages; (2) alcoholic beverages; (3) unsweetened beverages; and (4) low-calorie or artificially sweetened beverages. We estimated the adult nationwide baseline intake for each beverage category using 24-h dietary recall data collected in 2017/2018. Taking group one as the taxed beverages, we applied the price and cross-price elasticities to the baseline intake data, we obtained changes in caloric intake. The caloric reduction was introduced into an individual dynamic model to estimate changes in weight and obesity prevalence. No benefits on cost savings were modeled during the first 3 years of intervention to account for the time lag in obesity cases to reduce costs. We multiplied the reduction in obesity cases during 7 years by the obesity costs per capita to predict the costs savings attributable to the sweetened beverage tax. SSB price elasticities were higher among the lowest tertile of income (-1.24) than in the highest income tertile (-1.13), and cross-price elasticities suggest SSB were weakly substituted by milk, water, and 100% fruit juices. We estimated a caloric change of -17.3 kcal/day/person under a 20% excise tax and -25.9 kcal/day/person under a 30% tax. Ten years after implementation, a 20% tax is expected to reduce obesity prevalence by 6.7%; 9.1% for a 30% tax. These reductions translate into a -2.8 million and -3.8 million obesity cases for a 20% and 30% tax, respectively, and a reduction of $US 13.3 billion and $US 17.9 billion in obesity costs over 10 years for a 20% and 30% tax, respectively. Study limitations include using a quantile distribution method to adjust self-reported baseline weight and height, which could be insufficient to correct for reporting bias; also, weight, height, and physical activity were assumed to be steady over time. CONCLUSIONS: Adding a 20% to 30% excise tax on top of Brazil's current federal tax could help to reduce the consumption of ultra-processed beverages, empty calories, and body weight while avoiding large health-related costs. Given the recent cuts to SSB taxes in Brazil, a program to revise and implement excise taxes could prove beneficial for the Brazilian population.

City-Level Sugar-Sweetened Beverage Taxes and Youth Body Mass Index Percentile.

Importance: Levying excise taxes on sugar-sweetened beverage (SSB) distributors, which are subsequently passed on to consumers, is a policy implemented to reduce the high prevalence of cardiometabolic disease and generate public health funding. Taxes are associated with lower SSB purchases and consumption, but it is unknown whether they are associated with weight-related outcomes in youth. Objective: To determine the association of SSB excise taxes with youth body mass index (BMI) trajectories. Design, Setting, and Participants: This cohort study was conducted from 2009 to 2020, including 6 years before tax implementation and 4 to 6 years after tax implementation. The California cities of Albany, Berkeley, Oakland, and San Francisco, which implemented SSB excise taxes, were compared against 40 demographically matched control cities in California. Participants included Kaiser Permanente members aged 2 to 19 years at cohort entry (baseline) with continuous residence in selected cities with at least 1 pretax and 1 posttax BMI recorded in their electronic health record. Data analysis was performed from January 2021 to May 2023. Exposure: Implementation of SSB excise taxes. Main Outcomes and Measures: Centers for Disease Control and Prevention age-specific and sex-specific BMI percentiles and percentage of youth with overweight or obesity before tax implementation through 4 to 6 years after implementation were compared with control cities. Statistical analysis was conducted using the difference-in-differences (DID) method. A sensitivity analysis used the synthetic control method. Results: A total of 44 771 youth (mean [SD] age at baseline, 6.4 [4.2] years; 22 337 female [49.9%]) resided in the cities with SSB taxes; 345 428 youth (mean [SD] age, 6.9 [4.2] years; 171 0168 female [49.5%]) resided in control cities. There was a -1.64-percentage point (95% CI, -3.10 to -0.17 percentage points) overall difference in the mean change of BMI percentile between exposure and control cities after SSB tax implementation. There was no significant overall difference in the percentage of youth with overweight or obesity or youth with obesity compared with control cities. All DID estimates were significant for youth residing in exposure cities in terms of BMI percentile (age 2-5 years in 2017, -2.06 percentage points [95% CI, -4.04 to -0.09 percentage points]; age 6-11 years in 2017, -2.79 percentage points [95% CI, -4.29 to -1.30 percentage points]), percentages of youth with overweight or obesity (age 2-5 years, -5.46 percentage points [95% CI, -8.47 to -2.44 percentage points]; age 6-11 years, -4.23 percentage points [95% CI, -6.90 to -1.57 percentage points]), and percentages of youth with obesity (age 2-5 years; -1.87 percentage points [95% CI, -3.36 to -0.38 percentage points]; age 6-11 years, -1.85 percentage points [95% CI, -3.46 to -0.24 percentage points]). Compared with control cities, changes in mean BMI percentiles were significant for male (-1.98 percentage points; 95% CI, -3.48 to -0.48 percentage points), Asian (-1.63 percentage points; 95% CI, -3.10 to -0.16 percentage points), and White (-2.58 percentage points; 95% CI, -4.11 to -1.10 percentage points) youth. Compared with control cities, White youth in exposure cities had improvements in the percentage with overweight or obesity (-3.73 percentage points; 95% CI, -6.11 to -1.35 percentage points) and the percentage with obesity (-2.78 percentage points; 95% CI, -4.18 to -1.37 percentage points). Conclusions and Relevance: In this cohort study, SSB excise taxes were associated with lower BMI percentile among youth. Policymakers should consider implementing SSB excise taxes to prevent or reduce youth overweight and obesity and, ultimately, chronic disease, particularly among children younger than 12 years.

Eco-friendly revenues for healthcare: assessing the relationship between green taxation, public health expenditures, and life expectancy in China.

Introduction: The synergy of green taxation, public health expenditures, and life expectancy emerges as a compelling narrative in the intricate symphony of environmental responsibility and public well-being. Therefore, this study examine the impact of green taxation on life expectancy and the moderating role of public health expenditure on the said nexus, particularly in the context of China, an emerging economy. Methods: Statistical data is collected from the National Bureau of Statistics of China to empirically examine the proposed relationships. The dataset contains provincial data across years. Results: Using fixed-effect and system GMM regression models alongwith control variables, the results found a positive and statistically significant influence of green taxation on life expectancy. Moreover, public health expenditures have a positive and statistically significant partial moderating impact on the direct relationship. Discussion: These findings suggest that the higher cost of pollution encourages individuals and businesses to shift to less environmentally harmful alternatives, subsequently improving public health. Moreover, government investment in the health sector increases the availability and accessibility of health facilities; thus, the positive impact of green taxation on public health gets more pronounced. The findings significantly contribute to the fields of environmental and health economics and provide a new avenue of research for the academic community and policymakers.

A taxing problem: The impacts of research payment practices on participants and inclusive research.

Empirical data regarding payments to participants in research is limited. This lack of information constrains our understanding of the effectiveness of payments to achieve scientific goals with respect to recruitment, retention, and inclusion. We conducted a content analysis of consent forms and protocols available on clinicaltrials.gov to determine what information researchers provide regarding payment. We extracted data from HIV (n = 101) and NIMH-funded studies (n = 65) listed on clinicaltrials.gov that had publicly posted a consent form. Using a manifest content analysis approach, we then coded the language regarding payment from the consent document and, where available, protocol for purpose and method of the payment. Although not part of our original planned analysis, the tax-related information that emerged from our content analysis of the consent form language provided additional insights into researcher payment practices. Accordingly, we also recorded whether the payment section mentioned social security numbers (or other tax identification number) in connection with payments and whether it made any statements regarding the Internal Revenue Service or the tax status of payments. We found studies commonly offered payment, but did not distinguish between the purposes for which payment may be offered (i.e., compensation, reimbursement, incentive, or appreciation). We also found studies that excluded some participants from receiving payment or treated them differently from other participants in the study. Differential treatment was typically linked to US tax laws and other legal requirements. A number of US studies also discussed the need to collect Social Security numbers and income reporting based on US tax laws. Collectively, these practices disadvantage some participants and may interfere with efforts to conduct more inclusive research.

The UK Soft Drinks Industry Levy and childhood hospital admissions for asthma in England.

Sugar sweetened beverage consumption has been suggested as a risk factor for childhood asthma symptoms. We examined whether the UK Soft Drinks Industry Levy (SDIL), announced in March 2016 and implemented in April 2018, was associated with changes in National Health Service hospital admission rates for asthma in children, 22 months post-implementation of SDIL. We conducted interrupted time series analyses (2012-2020) to measure changes in monthly incidence rates of hospital admissions. Sub-analysis was by age-group (5-9,10-14,15-18 years) and neighbourhood deprivation quintiles. Changes were relative to counterfactual scenarios where the SDIL wasn't announced, or implemented. Overall, incidence rates reduced by 20.9% (95%CI: 29.6-12.2). Reductions were similar across age-groups and deprivation quintiles. These findings give support to the idea that implementation of a UK tax intended to reduce childhood obesity may have contributed to a significant unexpected and additional public health benefit in the form of reduced hospital admissions for childhood asthma.

Tax structure, government debt, and the relative power of local education supply.

Policymakers are increasingly focusing on structural adjustment and efficiency to cope with the pressures that the economic downturn has placed on local finances. Accordingly, the Chinese government should shift from using standard passive investments to high-quality active investments for its social guarantees, such as education. Based on panel data of 274 cities from 2010 to 2019, this study conducted the first examination of the impact of tax structure and government debt on the relative power of the local education supply (LES) in China. The study found that, first, in general, increases in the tax structure-represented by the proportion of personal income tax to budgetary revenue strengthen the relative power of LES, which is more sensitive in the southern region with a more developed market economy system. And the impact of government debt-represented by the urban investment debt ratio on the relative power of LES is initially negative and then positive. Second, the study revealed that the tax structure can stimulate the relative power of LES through the intermediary channel of an increase in the urban consumption rate; however, the mechanism of promoting the relative power of LES by encouraging localities to attract more floating populations is not obvious. Third, excessive investment in local governance adjusts the positive effect of local debt on the relative power of LES. Therefore, the government should pay attention to the promotion of personal income tax status, standardize their debt risk management, improve the efficiency of governance, and emphasize the pull of urban consumption, so as to enhance the ability to support livelihood and fully mobilize initiatives for local education development.

The impact of China's value-added tax credit refunds on enterprise labor demand: Ex-ante analysis and ex-post test.

This paper aims to explore the impact of China's value-added tax (VAT) credit refunds policy on the enterprises' labor demand through a paradigm combining ex-ante analysis and ex-post test. By introducing the VAT credit refunds into the production-decision model of the enterprise, calibrating the parameters and conducting the dynamic effects tests using the data of Chinese A-share listed enterprises, this paper finds that the labor employment of the pilot enterprises exhibits a V-shaped fluctuation trend. In the initial implementation of the policy, due to the existence of layoff costs, iso-cost line of the enterprise bends, which results in that the enterprise with a capital-labor substitution elasticity greater than 1 will not reduce labor hiring, as it has already deployed labor force before the implementation of the policy. When the enterprise enter the next production cycle where the labor force can be freely allocated, the labor employment of the enterprise with a capital-labor elasticity of substitution greater than 1 will decline compared to that without the policy. In the long run, as output increases, the labor demand will recover. The results of ex-post test are consistent with that of the ex-ante analysis. Additionally, heterogeneity test reveals that the greater the elasticity of capital-labor substitution of the sub-industry is, the more severe the degree of the V-shaped fluctuation is. Following the implementation of the policy, the continuous increase in enterprise output and capital stock verifies the relevant transmission mechanism. This study provides a more detailed perspective for comprehensively understanding the impact of VAT credit refunds policy on employment.

Beer taxes associate with lower alcohol and cigarette use; cigarette taxes associate with lower cigarette but higher alcohol use.

Background: There is a yet unmet opportunity to utilize data on taxes and individual behaviors to yield insight for analyzing studies involving alcohol and cigarette use.Objectives: To inform the direction and strength of their mutual associations by leveraging the fact that taxation can affect individual consumption, but individual consumption cannot affect taxation.Methods: We linked state-level data on cigarette and beer taxes in 2009-2020 with individual-level data on self-reported current cigarette and alcohol use from the Behavioral Risk Factor Surveillance System, a telephone survey by the Centers for Disease Control and Prevention that is representative of the population of each state in the United States. We constructed linear and logistic models to examine associations between a $1 increase in cigarette taxes per pack and a $1 increase in beer taxes per gallon and self-reported cigarette use and alcohol consumption (assessed as any current intake, average drinks/day, heavy drinking, and binge drinking), adjusting for survey year and individual characteristics.Results: Among 2,968,839,352 respondents (49% male), a $1 increase in beer taxes was associated with .003 (95% confidence interval [CI] -.013, .008) fewer drinks/day and lower odds of any drinking (odds ratio [OR] = .81 95%CI .80, .83), heavy drinking (OR = .96 95%CI .93, .99), binge drinking (OR = .82 95%CI .80, .83), and smoking (OR = .98 95%CI .96, 1.00). In contrast, a $1 increase in cigarette taxes was associated with lower odds of smoking (OR = .94 95%CI .94, .95) but .007 (95%CI .005, .010) more drinks/day, and higher odds of any drinking (OR = 1.10 95%CI 1.10, 1.11), heavy drinking (OR = 1.02 95%CI 1.01, 1.02), and binge drinking (OR = .82 95%CI .80, .83).Conclusion: Higher beer taxes were associated with lower odds of drinking and smoking, but higher cigarette taxes were associated with lower odds of smoking and higher alcohol consumption. These results suggest that alcohol intake may be a determinant of cigarette use rather than cigarette use as a determinant of alcohol intake.

Emigration and fiscal gap in population-exporting region.

This paper analyzes how emigration impacts fiscal gap of population-exporting region in the long term. We construct a general equilibrium model of emigration and fiscal gap and make empirical verification using two-step system GMM model. Among the major lessons from this work, five general and striking results are worth highlighting: (1) the economic losses of emigration are the immediate cause of widening the fiscal gap. (2) in the short and long term, emigration can expand the fiscal revenue gap through the superimposed effect of tax rate and tax base. (3) the gap in fiscal expenditure is widened by the outflow of people in the short term. However, local governments would change the strategy to keep the spending gap from widening in the long run. (4) a positive impact of emigration on the fiscal gap. the more severe population emigration, the larger the fiscal gap. (5) when the trend of emigration becomes irreversible, the subsequent efforts of local governments to expand fiscal expenditure for attraction population would not only fail to revive the regional economy, but aggravate the expansion of fiscal gap. The contribution of research is twofold. On the one hand, it fills the theoretical gap between emigration and fiscal gap because previous studies have paid little attention to the fiscal problems of local government of population outflow. On the other hand, the selection of Northeast China that has been subject to long-term out-of-population migration is good evidence to verify this theory, which is tested very well using the 2S-GMM model. The comprehensive discussion on the relationship between emigration and fiscal gap is helpful to guide those continuous population-exporting regions that are facing a huge fiscal gap how to solve the fiscal gap and unsustainability from the perspective of fiscal revenue and expenditure.

Economic Evaluations of Obesity-Targeted Sugar-Sweetened Beverage (SSB) Taxes-A Review to Identify Methodological Issues.

INTRODUCTION: Economic evaluations of public health interventions like sugar-sweetened beverage (SSB) taxes face difficulties similar to those previously identified in other public health areas. This stems from challenges in accurately attributing effects, capturing outcomes and costs beyond health, and integrating equity effects. This review examines how these challenges were addressed in economic evaluations of SSB taxes. METHODS: A systematic review was conducted to identify economic evaluations of SSB taxes focused on addressing obesity in adults, published up to February 2021. The methodological challenges examined include measuring effects, valuing outcomes, assessing costs, and incorporating equity. RESULTS: Fourteen economic evaluations of SSB taxes were identified. Across these evaluations, estimating SSB tax effects was uncertain due to a reliance on indirect evidence that was less robust than evidence from randomised controlled trials. Health outcomes, like quality-adjusted life years, along with a healthcare system perspective for costs, dominated the evaluations of SSB taxes, with a limited focus on broader non-health consequences. Equity analyses were common but employed significantly different approaches and exhibited varying degrees of quality. CONCLUSION: Addressing the methodological challenges remains an issue for economic evaluations of public health interventions like SSB taxes, suggesting the need for increased attention on those issues in future studies. Dedicated methodological guidelines, in particular addressing the measurement of effect and incorporation of equity impacts, are warranted.

Inequality of the crowding-out effect of tobacco expenditure in Colombia.

In recent decades, policy initiatives involving increases in the tobacco tax have increased pressure on budget allocations in poor households. In this study, we examine this issue in the context of the expansion of the social welfare state that has taken place over the last two decades in several emerging economies. This study explores the case of Colombia between 1997 and 2011. In this period, the budget share of the poorest expenditure quintile devoted to tobacco products of smokers' households doubled. We analyse the differences between the poorest and richest quintiles concerning the changes in budget shares, fixing a reference population over time to avoid demographic composition confounders. We find no evidence of crowding-out of education or healthcare expenditures. This is likely to be the result of free universal access to health insurance and basic education for the poor. For higher-income households, tobacco crowds out expenditures on entertainment, leisure activities, and luxury expenditures. This finding should reassure policymakers who are keen to impose tobacco taxes as an element of their public health policy.

A study on the "Porter Hypothesis" effect of the regulatory measures of the environmental protection tax law in the post-pandemic era.

The implementation of the Environmental Protection Tax Law was a significant milestone in China's environmental tax reform. The implementation of this law was influenced throughout the three-year period of epidemic prevention and control (from early 2020 to the end of 2022). Heavily polluting enterprises are the primary focus of regulations under the Environmental Protection Tax Law. This study conducts an empirical analysis using a structural equation model, leveraging sample data obtained from heavily polluting enterprises in China. The findings indicate that during the three-year period of epidemic prevention and control, the Porter Hypothesis effect was realized in terms of tax fairness but not in terms of tax rationality. Therefore, environmental tax law reforms should be pursued and tax authorities in China should make vigorous efforts to enhance the rationality of environmental taxation. This would improve the comprehensiveness of the "Porter Hypothesis" effect, fully harnessing the dual functions of environmental protection and the economic driving force embodied by the Environmental Protection Tax Law.

Equity implications of tobacco taxation: results from WHO FCTC investment cases.

BACKGROUND: Across time, geographies and country income levels, smoking prevalence is highest among people with lower incomes. Smoking causes further impoverishment of those on the lower end of the income spectrum through expenditure on tobacco and greater risk of ill health. METHODS: This paper summarises the results of investment case equity analyses for 19 countries, presenting the effects of increased taxation on smoking prevalence, health and expenditures. We disaggregate the number of people who smoke, smoking-attributable mortality and cigarette expenditures using smoking prevalence data by income quintile. A uniform 30% increase in price was applied across countries. We estimated the effects of the price increase on smoking prevalence, mortality and cigarette expenditures. RESULTS: In all but one country (Bhutan), a one-time 30% increase in price would reduce smoking prevalence by the largest percent among the poorest 20% of the population. All income groups in all countries would spend more on cigarettes with a 30% increase in price. However, the poorest 20% would pay an average of 12% of the additional money spent. CONCLUSIONS: Our results confirm that health benefits from increases in price through taxation are pro-poor. Even in countries where smoking prevalence is higher among wealthier groups, increasing prices can still be pro-poor due to variable responsiveness to higher prices. The costs associated with higher smoking prevalence among the poor, together with often limited access to healthcare services and displaced spending on basic needs, result in health inequality and perpetuate the cycle of poverty.

Simulated impact of medicaid expansion on the economic burden of opioid use disorder in North Carolina.

BACKGROUND: Opioid use disorder (OUD) imposes significant costs on state and local governments. Medicaid expansion may lead to a reduction in the cost burden of OUD to the state. METHODS: We estimated the health care, criminal justice and child welfare costs, and tax revenue losses, attributable to OUD and borne by the state of North Carolina in 2022, and then estimated changes in the same domains following Medicaid expansion in North Carolina (adopted in December 2023). Analyses used existing literature on the national and state-level costs attributable to OUD to estimate individual-level health care, criminal justice, and child welfare system costs, and lost tax revenues. We combined Individual-level costs and prevalence estimates to estimate costs borne by the state before Medicaid expansion. Changes in costs after expansion were computed based on a) medication for opioid use disorder (MOUD) access for new enrollees and b) shifting of responsibility for some health care costs from the state to the federal government. Monte Carlo simulation accounted for the impact of parameter uncertainty. Dollar estimates are from the 2022 price year, and costs following the first year were discounted at 3 %. RESULTS: In 2022, North Carolina incurred costs of $749 million (95 % credible interval [CI]: $305 M-$1,526 M) associated with OUD (53 % in health care, 36 % in criminal justice, 7 % in lost tax revenue, and 4 % in child welfare costs). Expanding Medicaid lowered the cost burden of OUD incurred by the state. The state was predicted to save an estimated $72 million per year (95 % CI: $6 M-$241 M) for the first two years and $30 million per year (95 % CI: -$28 M-$176 M) in subsequent years. Over five years, savings totaled $224 million (95 % CI: -$47 M-$949 M). CONCLUSION: Medicaid expansion has the potential to decrease the burden of OUD in North Carolina, and policymakers should expedite its implementation.