Cui Chengsen, Zhang Yue, Ding Ruoxi, He Ping
School of Public Health, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China; China Center for Health Development Studies, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China.
School of Accountancy, Central University of Finance and Economics, No.39 South College Road, Haidian District, Beijing, 100081, China.
Soc Sci Med. 2024 Mar;345:116705. doi: 10.1016/j.socscimed.2024.116705. Epub 2024 Feb 23.
The Chinese government launched the Essential Public Health Service (EPHS) program nationwide in 2009. However, prior studies have not provided clear and integrated evidence on whether the EPHS program improves health outcomes and prevents financial risks among individuals. Because hypertension is the chronic disease with the highest prevalence, this study evaluated the impact of the EPHS program among hypertensive patients to provide evidence for the progress of the program.
A cohort of hypertensive patients was identified from the 2011-2018 China Health and Retirement Longitudinal Study (CHARLS). The outcomes assessed included hospitalization expenditure, outpatient expenditure and cardiovascular disease (heart attack and stroke). The key independent variable was whether an individual received EPHS-covered blood pressure measurements in 2013-2015. Based on the International Health Partnership+ (IHP+) common monitoring and evaluation (M&E) framework, a difference-in-differences (DID) method with propensity score matching (PSM) was used to examine the impact of the EPHS program on hypertensive patients.
The results showed that among hypertensive patients covered by the EPHS program, outpatient total costs/OOP costs were reduced by 29.8% and 30.8%, respectively, and hospitalization total costs/OOP costs were reduced by 34.9% and 35.6%, respectively. The EPHS program reduced the probability of heart attack and stroke among hypertensive patients by 3.5% and 2.7%, respectively. Mechanistic tests showed that the EPHS program improved health outcomes by reducing alcohol consumption and increasing physical activity, thereby further reducing health expenditure among hypertensive patients. The impacts of the EPHS program on hypertensive patients varied by age, educational attainment, residential region, and alcohol consumption status.
The EPHS program in China significantly improved health outcomes and prevented financial risks for hypertensive patients. This evidence provides a valuable reference for low- and middle-income countries with their essential public health service programs.
中国政府于2009年在全国范围内启动了基本公共卫生服务（EPHS）项目。然而，先前的研究尚未提供关于EPHS项目是否能改善健康状况并预防个人财务风险的清晰且综合的证据。由于高血压是患病率最高的慢性病，本研究评估了EPHS项目对高血压患者的影响，以为该项目的进展提供证据。
从2011 - 2018年中国健康与养老追踪调查（CHARLS）中确定一组高血压患者。评估的结果包括住院费用、门诊费用和心血管疾病（心脏病发作和中风）。关键自变量是个体在2013 - 2015年是否接受了EPHS覆盖的血压测量。基于国际卫生伙伴关系升级版（IHP +）的通用监测与评价（M&E）框架，采用倾向得分匹配（PSM）的双重差分（DID）方法来检验EPHS项目对高血压患者的影响。
结果显示，在EPHS项目覆盖的高血压患者中，门诊总费用/自付费用分别降低了29.8%和30.8%，住院总费用/自付费用分别降低了34.9%和35.6%。EPHS项目使高血压患者心脏病发作和中风的概率分别降低了3.5%和2.7%。机制检验表明，EPHS项目通过减少饮酒和增加身体活动改善了健康状况，从而进一步降低了高血压患者的医疗支出。EPHS项目对高血压患者的影响因年龄、教育程度、居住地区和饮酒状况而异。
中国的EPHS项目显著改善了高血压患者的健康状况并预防了财务风险。这一证据为中低收入国家开展基本公共卫生服务项目提供了有价值的参考。
