作品簡介:盡管證據表明酒精定價政策減少與酒精有關的健康危害是健壯的,和酒精稅收增加是一個“百思買”幹預,缺乏比較研究的規模和分布在社會選擇帶來的健康影響稅收和價格政策選項。本研究的目的是測試四種常見酒精稅收和定價策略是否有不同的影響健康的不平等。

方法和結果:計量經濟學的流行病學模型建立與英國2014/2015的設置。四個定價策略上實現當前稅收扳平比分給同一全民減少4.3%與酒精有關的死亡率:當前增加稅收,增加13.4%所有產品責任在當前英國係統;價值稅,4.0%的從價稅基於產品價格;strength-based稅,每英國酒精單位體積£0.22的稅(= 8 g(乙醇);和最小單位定價,£0.50單位的最低價格門檻,低於這個酒精不能出售。模型輸入計算結合家庭抽樣調查的數據對酒精購買和消費,在43個酒精造成的疾病管理和醫療數據,公布價格彈性和相對風險函數。結果年度人均消費,消費支出,與酒精有關的死亡。不確定性評估通過局部概率敏感性分析(PSA)和場景分析。定價策略的不同分布在人口的影響,如何,從公共健康的角度來看,酗酒者在常規/手動職業是一組關鍵的風險最大的健康危害飲用。Strength-based稅收和最小單位價格將有更大的影響死亡率的飲酒者常規/手工工作(尤其是重度飲酒者,估計政策對死亡率的影響如下:目前的增稅,-3.2%; value-based tax, -2.9%; strength-based tax, -6.1%; minimum unit pricing, -7.8%) and lesser impacts among drinkers in professional/managerial occupations (for heavy drinkers: current tax increase, -1.3%; value-based tax, -1.4%; strength-based tax, +0.2%; minimum unit pricing, +0.8%). Results from the PSA give slightly greater mean effects for both the routine/manual (current tax increase, -3.6% [95% uncertainty interval (UI) -6.1%, -0.6%]; value-based tax, -3.3% [UI -5.1%, -1.7%]; strength-based tax, -7.5% [UI -13.7%, -3.9%]; minimum unit pricing, -10.3% [UI -10.3%, -7.0%]) and professional/managerial occupation groups (current tax increase, -1.8% [UI -4.7%, +1.6%]; value-based tax, -1.9% [UI -3.6%, +0.4%]; strength-based tax, -0.8% [UI -6.9%, +4.0%]; minimum unit pricing, -0.7% [UI -5.6%, +3.6%]). Impacts of price changes on moderate drinkers were small regardless of income or socioeconomic group. Analysis of uncertainty shows that the relative effectiveness of the four policies is fairly stable, although uncertainty in the absolute scale of effects exists. Volumetric taxation and minimum unit pricing consistently outperform increasing the current tax or adding an ad valorem tax in terms of reducing mortality among the heaviest drinkers and reducing alcohol-related health inequalities (e.g., in the routine/manual occupation group, volumetric taxation reduces deaths more than increasing the current tax in 26 out of 30 probabilistic runs, minimum unit pricing reduces deaths more than volumetric tax in 21 out of 30 runs, and minimum unit pricing reduces deaths more than increasing the current tax in 30 out of 30 runs). Study limitations include reducing model complexity by not considering a largely ineffective ban on below-tax alcohol sales, special duty rates covering only small shares of the market, and the impact of tax fraud or retailer non-compliance with minimum unit prices.

結論:我們的模型估計,而增稅在當前係統或引入稅收根據產品價值,alcohol-content-based稅收或最小單位定價將會導致更大的收入群體減少衛生不公平現象。我們也估計alcohol-content-based稅收和最小單位定價會有害飲酒影響最大,對那些喝適量用最小的影響。