Population impact of reimbursement for smoking cessation: a natural experiment in the Netherlands

Aims To report on the impact of financial reimbursement of pharmacotherapy for smoking cessation in combination with behavioural support on the number of enrollees to proactive counselling in the Dutch national quitline. Design Descriptive timeseries analysis was used to compare quitline enrolment in 2010 and 2012 (no reimbursement) with 2011 (reimbursement). Settings National smoking cessation quitline. Participants Smokers signing up for proactive counselling. Measurements Treatment enrolment data recorded by the quitline as part of usual care from 2010, 2011 and 2012 (until May). Findings In 2010, a total of 848 smokers started treatment. In 2011, 9091 smokers enrolled. In 2012, the number of enrollees dropped dramatically, even below the 2010 level. In addition, the proportion of smokers in the population dropped from 27.2% in 2010 to 24.7% in 2011. Conclusions The introduction of a national reimbursement system in the Netherlands was associated with a more than 10-fold increase in telephone counselling for smoking cessation and suggests that reimbursement for smoking cessation contributed to improvements in public health.