[WITHDRAWN] The importance of increasing cigarette prices on National Health Insurance financing in Indonesia

Renny Nurhasana, Risky Kusuma Hartono, Faizal Rahmanto Moeis, Suci Puspita Ratih


Indonesia faces the combined challenges of a high prevalence of active smokers and an increased financial burden of smoking-related Non-Communicable Diseases (NCDs) on National Health Insurance (NHI). This study aims to assess the importance of increasing cigarette prices for NHI funding. It was a cross-sectional study conducted through a phone survey. The survey was administered to 1,000 respondents aged 18 and over from various telecommunications operators in Indonesia. We performed the multivariate analysis and the framework of the importance of increasing cigarette prices for funding NHI. The result shows that the majority of the public supports the increase of cigarette price for funding NHI except for active smokers at Odds Ratio=0.529. The importance of increasing cigarette prices for funding NHI is supported by society, able to reduce the prevalence of active smokers, and it raises the government’s tax income. With the current strong public support, cigarette prices should be increased which will then be tagged to fund the NHI consistently. This is also seen as a means to compensate the high NCD-related claims of the NHI which are caused by smoking behavior.

JEL Classification  H51; I13; I18 


cigarette; national health insurance; non-communicable diseases; tax

Article Metrics

Abstract view : 2 times


Alpert, H. R., Vardavas, C. I., Chaloupka, F. J., Vozikis, A., Athanasakis, K., Kyriopoulos, I., … Connolly, G. N. (2014). The recent and projected public health and economic benefits of cigarette taxation in Greece. Tobacco Control, 23(5), 452–454. https://doi.org/10.1136/tobaccocontrol-2012-050857

Bappenas. (2014). Rencana Pembangunan Jangka Menengah Nasional (RPJMN) 2015–2019. Peraturan Presiden Republik Indonesia Nomor, 2.

Bardach, A. E., Caporale, J. E., Alcaraz, A., Augustovski, F., Huayanay-Falconí, L., Loza-Munarriz, C., … Pichon-Riviere, A. (2016). Burden of smoking-related disease and potential impact of cigarette price increase in Peru. Revista Peruana de Medicina Experimental y Salud Pública, 33(4), 651. https://doi.org/10.17843/rpmesp.2016.334.2548

Blakely, T., Cobiac, L. J., Cleghorn, C. L., Pearson, A. L., van der Deen, F. S., Kvizhinadze, G., … Wilson, N. (2015). Health, health inequality, and cost impacts of annual increases in tobacco tax: Multistate life table modeling in New Zealand. PLoS Medicine, 12(7), 1–21. https://doi.org/10.1371/journal.pmed.1001856

BPJS Kesehatan. (2018). RDP BPJS Kesehatan dengan Komisi IX DPR Republik Indonesia. Jakarta: Badan Pelenyelenggara Jaminan Sosial Kesehatan.

Brock, B., Choi, K., Boyle, R. G., Moilanen, M., & Schillo, B. A. (2016). Tobacco product prices before and after a statewide tobacco tax increase. Tobacco Control, 25(2), 166–173. https:// doi.org/10.1136/tobaccocontrol-2014-052018

Cavazos-Rehg, P. A., Krauss, M. J., Spitznagel, E. L., Chaloupka, F. J., Luke, D. A., Waterman, B., … Bierut, L. J. (2014). Differential effects of cigarette price changes on adult smoking behaviours. Tobacco Control, 23(2), 113–118. https://doi.org/10.1136/tobaccocontrol-2012-050517

Dara, A. L., Burhanuddin, B., & Nurhaedar, J. (2011). Kebiasaan merokok dan asupan makanan terhadap status gizi manula kelurahan Balla Kabupaten Enrekang. Universitas Hasanudin Makasar: Makassar.

Dartanto, T., Halimatussadiah, A., Rezki, J. F., Nurhasana, R., Siregar, C. H., Bintara, H., … Soeharno, R. (2020). Why Do Informal Sector Workers Not Pay the Premium Regularly? Evidence from the National Health Insurance System in Indonesia. Applied Health Economics and Health Policy, 18(1), 81–96. https://doi.org/10.1007/s40258-019-00518-y

Farrelly, M. C., Nonnemaker, J. M., & Watson, K. A. (2012). The Consequences of High Cigarette Excise Taxes for Low-Income Smokers. Plos One, 7(9), 1–7. https://doi.org/10.1371/journal.pone.0043838

Filippidis, F. T. (2016). Tobacco control: a victim of political instability in Greece. The Lancet, 387(10016), 338–339. https://doi.org/10.1016/S0140-6736(16)00110-0

Fosson, G. H., McCallum, D. M., & Beeson, D. H. (2014). The Health and Economic Consequences of Cigarette Smoking in Alabama, 2009–2010. Public Health Reports, 129(6), 486–490. https://doi.org/10.1177/003335491412900606

Gardner, B., & West, R. (2010). Public support in England for raising the price of cigarettes to fund tobacco control activities. Tobacco Control, 19(4), 331–333. https://doi.org/10.1136/tc.2009.033274

Goodchild, M., Perucic, A.-M., & Nargis, N. (2016). Modelling the impact of raising tobacco taxes on public health and finance. Bulletin of the World Health Organization, 94(4), 250.

Hartono, R. K. (2017). Equity Level of Health Insurance Ownership in Indonesia. National Journal Public Health, vol 12(50), 93–100. https://doi.org/10.21109/kesmas.v12i2.1408

Hidayat, B., & Thabrany, H. (2011). Are smokers rational addicts? Empirical evidence from the Indonesian Family Life Survey. Harm Reduction Journal, 8(1), 6. https://doi.org/10.1186/1477-7517-8-6

Indonesia Ministry of Finance. (2018). Kebijakan Pajak Rokok, Pemungutan, Penyetoran dan Penggunaan. Jakarta: Ministry of Finance Republic of Indonesia.

Indonesia Ministry of Finance. (2020). Peraturan Menteri Keuangan (PMK) 198 tahun 2020 tentang Tarif Cukai Hasil Tembakau. Jakarta: Indonesia Ministry of Finance.

Indonesia Ministry of Health. (2018). RISKESDAS 2018. Jakarta [ID]: Balitbangkes Kemenkes RI.

Jamison, D., Summers, L., Alleyne, G., Arrow, K., Berkley, S., Binagwaho, A., … Yamey, G. (2013). Global health 2035: A world converging within a generation. Lancet, 382, 1898–1955. https://doi.org/10.1016/S0140-6736(13)62105-4

Jha, P., & Peto, R. (2014). Global Effects of Smoking, of Quitting, and of Taxing Tobacco. New England Journal of Medicine, 370(1), 60–68. https://doi.org/10.1056/NEJMra1308383

Kusumawardani, N., Tarigan, I., Suparmi, & Schlotheuber, A. (2018). Socio-economic, demographic and geographic correlates of cigarette smoking among Indonesian adolescents: results from the 2013 Indonesian Basic Health Research (RISKESDAS) survey. Global Health Action, 11(sup1), 54–62. https://doi.org/10.1080/16549716.2018.1467605

Lam, T. H. (2007). IARC Handbooks of cancer prevention: Tobacco control, v. 11: Reversal of risk after quitting smoking. International Agency for Research on Cancer.

Liber, A. C., Ross, H., Ratanachena, S., Dorotheo, E. U., & Foong, K. (2015). Cigarette price level and variation in five Southeast Asian countries. Tobacco Control, 24(E2), e137–e141. https://doi.org/10.1136/tobaccocontrol-2013-051184

Lightwood, J., & Glantz, S. A. (2013). The Effect of the California Tobacco Control Program on Smoking Prevalence, Cigarette Consumption, and Healthcare Costs: 1989–2008. PLoS ONE, 8(2), e47145. https://doi.org/10.1371/journal.pone.0047145

Marquez, P. V, & Moreno-Dodson, B. (2017). Tobacco tax reform at the crossroads of health and development: a multisectoral perspective. World Bank. Retrieved from https://openknowledge.worldbank.org/handle/10986/28494

Marten, R., Kadandale, S., Butler, J., Aguayo, V. M., Axelrod, S., Banatvala, N., … Webb, D. (2018). Sugar, tobacco, and alcohol taxes to achieve the SDGs. The Lancet, 391(10138), 2400–2401. https://doi.org/10.1016/S0140-6736(18)31219-4

McNaughton, S. A., Crawford, D., Ball, K., & Salmon, J. (2012). Understanding determinants of nutrition, physical activity and quality of life among older adults: the Wellbeing, Eating and Exercise for a Long Life (WELL) study. Health and Quality of Life Outcomes, 10(1), 109. https://doi.org/10.1186/1477-7525-10-109

Ng, M., Freeman, M. K., Fleming, T. D., Robinson, M., Dwyer-Lindgren, L., Thomson, B., … Gakidou, E. (2014). Smoking Prevalence and Cigarette Consumption in 187 Countries, 1980-2012. JAMA, 311(2), 183. https://doi.org/10.1001/jama.2013.284692

Nugraheni, W. P., & Hartono, R. K. (2017). Analisis Pola Layanan Kesehatan Rawat Jalan pada Tahun Pertama Implementasi Program Jaminan Kesehatan Nasional (JKN). Media Penelitian Dan Pengembangan Kesehatan, 27(1). https://doi.org/10.22435/mpk.v27i1.6000.9-16

Nurhasana, R., Ratih, S. P., Dartanto, T., Moeis, F. R., Hartono, R. K., Satrya, A., & Thabrany, H. (2020). Public support for cigarette price increase in Indonesia. Tobacco Control, tobaccocontrol-2019-055554. https://doi.org/10.1136/ tobaccocontrol-2019-055554

O’Donnell, O., Van Doorslaer, E., Rannan-Eliya, R. P., Somanathan, A., Adhikari, S. R., Harbianto, D., … Karan, A. (2007). The incidence of public spending on healthcare: comparative evidence from Asia. The World Bank Economic Review, 21(1), 93–123. https://doi.org/10.1093/wber/lhl009

Perriot, J., Underner, M., Peiffer, G., Le Houezec, J., Samalin, L., Schmitt, A., … Doly-Kuchcik, L. (2012). Le sevrage tabagique des « fumeurs difficiles ». Revue Des Maladies Respiratoires, 29(4), 448–461. https://doi.org/10.1016/j.rmr.2011.09.048

Republic of Indonesia. (2004). Undang-Undang Nomor 40 tahun 2004 tentang Sistem Jaminan Sosial Nasional. Jakarta: Republik Indonesia.

Republic of Indonesia. (2018). Peraturan Presiden Republik Indonesia Nomor 82 Tahun 2018 Tentang Jaminan Kesehatan. Jakarta: Indonesia Republic.

Riahi, M., Rohani, H., Rajabi, N., & Bidkhori, M. (2018). Tobacco tax and price in the developed and developing countries in the World. Data in Brief, 20, 767–774. https://doi.org/10.1016/j.dib.2018.06.100

Rodríguez-Iglesias, G., Schoj, V., Chaloupka, F., Champagne, B., & González-Rozada, M. (2017). Analysis of cigarette demand in Argentina: the impact of price changes on consumption and government revenues. Salud Pública de México, 59(1), 95. https://doi.org/10.21149/7861

Salti, N., Brouwer, E., & Verguet, S. (2016). The health, financial and distributional consequences of increases in the tobacco excise tax among smokers in Lebanon. Social Science and Medicine, 170, 161–169. https://doi.org/10.1016/j.socscimed.2016.10.020

Schane, R. E., Ling, P. M., & Glantz, S. A. (2010). Health Effects of Light and Intermittent Smoking. Circulation, 121(13), 1518–1522. https://doi.org/10.1161/CIRCULATIONAHA.109.904235

Tan Y. L. (2016). Earmarked tobacco taxes : Lesson learnt from nine countries. Geneva: World Health Organization.

Thabrany, H., & Laborahima, Z. (2016). People’s Support on Sin Tax to Finance UHC in Indonesia, 2016. Jurnal Ekonomi Kesehatan Indonesia, 1(1). Retrieved from http://journal.fkm.ui.ac.id/jurnal-eki/article/view/1759

Van Baal, P. H. M., Brouwer, W. B. F., Hoogenveen, R. T., & Feenstra, T. L. (2007). Increasing tobacco taxes: A cheap tool to increase public health. Health Policy, 82(2), 142–152. https://doi.org/10.1016/j.healthpol.2006.09.004

Verguet, S., Gauvreau, C. L., Mishra, S., MacLennan, M., Murphy, S. M., Brouwer, E. D., … Jamison, D. T. (2015). The consequences of tobacco tax on household health and finances in rich and poor smokers in China: An extended cost-effectiveness analysis. The Lancet Global Health, 3(4), e206–e216. https://doi.org/10.1016/S2214-109X(15)70095-1

WHO. (2012). Tobacco taxation and innovative health-care financing. World Health Organization. JOUR. Retrieved from https://apps.who.int/iris/handle/10665/206014

WHO. (2015). Illegal trade of tobacco products: What you should know to stop it. World Health Organization.


  • There are currently no refbacks.