Assesing the net fiscal consequences of tobacco use in a high consumption and high tobacco tax country: The case of Greece

Objectives: Greece has increasing prevalence of tobacco use and one of the highest consumption rates in Europe. Notwithstanding that tobacco tax is an important fiscal revenue, smoking represents a major public health threat causing premature mortality, morbidity, costs and foregone productivity which are a major source of fiscal loss. The objective of this study was to assess the net fiscal impact of hypothetic tax increases to inform public policy. Methods: Evidence for the prevalence of smoking and smoking-attributable mortality (SAM) in Greece was synthesized with economic data to assess the net fiscal impact of tobacco use. SAM was converted into productivity (earnings) loss and tax revenue (fiscal) loss. Mincer functions were used to project lifetime earnings and direct and indirect per person tax for smokers and ex-smokers. Average tobacco consumption was used to quantify the expected tax revenue from tobacco consumption tax and published price elasticities were employed to explore the impact of hypothetical tax and price increases. Results: The averted mortality, by a 10% increase in the price of tobacco products, is expected to avert productivity loss of € 4.4-6.9 million that corresponds to averted fiscal loss of € 1.5-2.5 million as measured by expected lifetime tax. Based on previous studies, healthcare cost savings were estimated by previous studies at € 24-€ 149 million. Higher price increases yielded higher epidemiological, societal and fiscal benefits. Tobacco consumption appears to be inelastic thus, tax revenue was not reduced in the absence of lower consumption. Conclusions: Smoking represents both a source of fiscal revenue and loss for central government. Price increases, through tobacco tax, may be a fiscally meaningful policy for reducing the burden of smoking. Although there are likely to be upper limits to which further tax increases will not discourage tobacco consumption. Assessing the net fiscal impact may be a useful tool for tobacco-control policy evaluation.