The association between smoking cessation outpatient visits and total medical costs: a retrospective,observational analysis of Japanese employee-based public health insurance data

Aims: The short-term effects of smoking cessation (SC) on overall healthcare costs are unclear. This study aimed to compare the short-term medical costs between patients with SC outpatient visits (SCOVs) and those without SCOVs, consisting of SCOV itself and overall medical costs.

Materials and methods: This study is a retrospective, observational study using a Japanese employee-based health insurance claims database (January 1, 2005–December 31, 2013). It analyzed individuals who were registered as smokers based on their medical checkup details. It compared the per-patient-per-year (PPPY) medical costs for male smokers who made ≥1 claim for SCOVs with those who made no claims. We also assessed whether the number of SCOVs by male and female smokers impacted medical costs. The Index Year was the year after the first SCOV claim and that after the first registration as a smoker (non-SCOV group). Medical costs were calculated using regression analysis and adjusted for baseline costs.

Results: In Index Year ?1, PPPY medical costs for male smokers were ～USD 323.01 (JPY 36,500, as of November 2017) higher in the SCOV (n?=?5,608) vs the non-SCOV (n?=?81,721) group; however, by Year 6 the costs were similar. From Year 4–6, PPPY medical costs for SCOVs were lower than those in the adjusted non-SCOV group. For 2,576 male and female smokers in the SCOV group, the average rates of increasing medical costs before and after the SCOV for 1, 2, 3, 4, and 5 SCOVs made were 58%, 44%, 50%, 41%, and 34%, respectively.

Limitations: The database includes limited data on individuals >65 years. Only SCOVs based on claims data and not on other outcomes were assessed.

Conclusions: Medical costs declined in the short-term following the first SCOV. Attendance at a greater number of SCOVs was associated with a lower increase ratio of medical costs.     

Examining the association of smoking with work productivity and associated costs in Japan

Aims: Smoking is associated with significant health and economic burden globally, including an increased risk of many leading causes of mortality and significant impairments in work productivity. This burden is attenuated by successful tobacco cessation, including reduced risk of disease and improved productivity. The current study aimed to show the benefits of smoking cessation for workplace productivity and decreased costs associated with loss of work impairment.

Materials and methods: The data source was the 2011 Japan National Health and Wellness Survey (n?=?30,000). Respondents aged 20–64 were used in the analyses (n?=?23,738) and were categorized into: current smokers, former smokers, and never smokers. Generalized linear models controlling for demographics and health characteristics examined the relationship of smoking status with the Work Productivity and Activity Impairment questionnaire (WPAI-GH) endpoints, as well as estimated indirect costs.

Results: Current smokers reported the greatest overall work impairment, including absenteeism (i.e. work time missed) and presenteeism (i.e. impairment while at work); however, after controlling for covariates, there were no significant differences between former smokers and never smokers on overall work impairment. Current smokers and former smokers had greater activity impairment (i.e. impairment in daily activities) than never smokers. Current smokers reported the highest indirect costs (i.e. costs associated with work impairment); however, after controlling for covariates, there were no significant differences between former smokers and never smokers on indirect costs.

Limitations and conclusions: Smoking exerts a large health and economic burden; however, smoking cessation attenuates this burden. The current study provides important further evidence of this association, with former smokers appearing statistically indistinguishable from never smokers in terms of work productivity loss and associated indirect costs among a large representative sample of Japanese workers. This report highlights the workplace benefits of smoking cessation across productivity markers and cost-savings.     

Intergenerational Wealth Mobility in France, 19th and 20th Century

This paper examines intergenerational wealth mobility between fathers and children in France between 1848 and 1960. Considering wealth mobility in the long run requires taking into account not only positional mobility (that is, how families move within a given distribution of wealth), but also structural mobility induced by changes in the distribution of wealth. Such changes are related to two structural phenomena: in the nineteenth century, the rising number of individuals leaving no estate at death and, after World War I, the decline in the number of the very rich who could live off their wealth. The paper studies the movements between these groups and estimates the intergenerational elasticity of wealth, taking into account the persistence at the bottom and at the top.     

A new when-to-schedule policy in online scheduling based on cumulative task delays

This paper proposes a new when-to-schedule policy in online scheduling, which considers timing of rescheduling based on the concept of a control limit policy and rolling schedules. Under the proposed policy, rescheduling is carried out based on a cumulative delay which can be a measure to determine suitable timing of rescheduling. Some computational experiments demonstrate the effectiveness of the proposed policy by applying it to single-machine dynamic scheduling with sequence-dependent setup times and urgent jobs, where total setups are minimized as well as rescheduling frequency. It is also demonstrated that the proposed policy can outperform typical rescheduling policies.     

Bankruptcy filings before and after implementation of the bankruptcy reform law

After the effective date of the Bankruptcy Reform Act (1979), bankruptcy filings rose sharply in most states. The increase can be ascribed partially to the fact that unemployment rose and working hours declined from 1978 to 1980. In addition, state laws on garnishment had a greater effect on bankruptcy filings in 1980 than in 1978. Nonetheless, a significant increase in filing rates from 1978 to 1980 could not be accounted for by changes in state laws or employment conditions. The evidence is consistent with the hypothesis that the Act, per se, contributed to the increase in bankruptcy filings.