So many public health initiatives end up doing most good for the better off. So it’s nice to hear of one that’s brought plenty of payoff to people at the other end of the socioeconomic spectrum.
Croakey’s North American correspondent, Dr Lesley Russell, reports below on new findings suggesting that targeting anti-smoking initiatives to the poorer sections of the community can bring significant health and financial gains.
“In November the Massachusetts Department of Public Health released the initial results from the program introduced just a year earlier to help people enrolled in the state’s medical insurance for the poor (Medicaid) program, MassHealth, quit smoking.
The results are dramatic – within just one year, users of the smoking cessation benefit had dramatic reductions in hospitalizations for heart attacks, declines in emergency and clinic visits for asthma, and a significant decrease in acute birth complications. In the first two and a half years of the benefit, over 75,000 MassHealth members have tried to quit smoking. This represents 40 percent of smokers on MassHealth.
Low-income smokers are among the most persistent smokers in the US and the most difficult to reach with campaigns to quit. That is in part due to the high cost of nicotine replacement drugs. As a result, smoking rates among the poor in Massachusetts have hovered close to 40 percent since the late 1990s – nearly 2.5 times the rate for all adults in the state, which is 16 percent.
The stop-smoking initiative, which covers virtually all the costs of cessation counseling and drugs (there is a $3 co-payment), was ordered by the state legislature as part of Massachusetts’s landmark health care overhaul in 2006, with the dual purpose of saving lives and money.
The Massachusetts Tobacco Cessation and Prevention Program (MTCP) and MassHealth worked together to design a barrier-free benefit that includes all FDA-approved medications to quit smoking and behavioral counseling. Beginning in July 2006, MassHealth began providing coverage of smoking cessation as part of the state’s health care reform initiative. The benefit was introduced into an environment that encourages quitting smoking: Massachusetts has smoke-free workplaces, high cigarette taxes (and taxes are also high in adjacent states), and a non-smoking social norm.
The state also took to the airwaves and the road, flooding food banks and medical clinics with more than 100,000 fliers touting the campaign. The expectation, based on the experience of other states and health plans, was that 5 to 10 percent of MassHealth patients who smoked might seek help in the first couple of years. But the program was flooded with people who wanted to quit but had not been able to afford the costs involved.
By the summer of 2008 – the latest data available – smoking rates among adults aged 18 to 64 enrolled in MassHealth had dropped to 29.6 percent. Over the same time frame the smoking rates in a control group with no insurance and no coverage for cessation remained largely unchanged at more than 36 percent.
MCTP researchers found that up to 38 percent fewer MassHealth cessation benefit users were hospitalized for heart attacks and 17 percent fewer benefit users visited the emergency room for asthma symptoms in the first year after using the benefit. Researchers also found that there were 17 percent fewer claims for adverse maternal birth complications since the benefit was implemented.
The state spent $10.9 million on tobacco cessation for MassHealth patients from July 2006 through June 2008. More than 8,000 Massachusetts residents die annually from the direct effects of smoking, and tobacco use is associated with $4.3 billion in excess health care costs in Massachusetts each year, so there are clear savings to be achieved here.
There are also clear lessons for the rest of the US and for Australia.”
• Dr Lesley Russell is the Menzies Foundation Fellow at the Menzies Center for Health Policy, University of Sydney/ Australian National University and a Research Associate at the US Studies Centre, University of Sydney. She is currently a Visiting Fellow at the Center for American Progress in Washington DC.