Influence of National Essential Public Health Services Policy on Expenditure for Hypertension in China: A Difference-in-Difference Analysis

Abstract

\n Background: The prevention and control of hypertension should be an effective way to reduce deaths and it has been a high priority in China. The Chinese government issued the National Essential Public Health Services Package (NEPHSP) in 2009; this initiative provides free public health services to meet the challenges posed by hypertension. It includes health education, regular health checkups, and regular follow-ups provided to patients with hypertension aged ≥ 35. This study explored the influence of the NEPHSP on outpatient and inpatient expenditure among patients with hypertension. Methods: Data were mined from the 2011–2015 Harmonized China Health and Retirement Longitudinal Study. The dependent variables were the outpatient and inpatient expenditure of patients with hypertension. The independent variable was defined as whether covered by the NEPHSP in 2013 or 2015. Using propensity score matching (PSM) to match the individual characteristics of hypertension in the NEPHSP-covered group and the NEPHSP-uncovered group, Tobit regression models with difference-in-differences (DID) were used to analyze the outcomes. Results: After PSM, of the 1,956 hypertensive participants, 369 had physical exams covered by the NEPHSP in 2013 and 2015. In 2013 and 2015, the outpatient and inpatient expenses of patients with hypertension increased compared with 2011. A DID estimate for the NEPHSP-covered service was associated with a marginal significant decrease of RMB 319.79 (p = 0.586) and RMB 1072.02 (p = 0.068) in hypertension inpatient expected expenditure in 2013 and 2015, respectively. The DID estimate showed no significant change among outpatient expected expenditure. Conclusions: The NEPHSP may reduce inpatient expenditure among patients with hypertension. Further strengthening of the NEPHSP may reduce their burden.