Impact of the Essential Public Health Service program on financial protection and health outcomes among hypertensive patients: A quasi-experimental study in China.

Autor: Cui C; 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. Electronic address: cuichengsen1230@hsc.pku.edu.cn., Zhang Y; School of Accountancy, Central University of Finance and Economics, No.39 South College Road, Haidian District, Beijing, 100081, China. Electronic address: zhangyue@cufe.edu.cn., Ding R; Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Commission Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), No.51 Hua Yuan Bei Road, Haidian District, Beijing, 100191, China. Electronic address: dingruoxi@163.com., He P; China Center for Health Development Studies, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China. Electronic address: phe@pku.edu.cn.
Jazyk: angličtina
Zdroj: Social science & medicine (1982) [Soc Sci Med] 2024 Mar; Vol. 345, pp. 116705. Date of Electronic Publication: 2024 Feb 23.
DOI: 10.1016/j.socscimed.2024.116705
Abstrakt: Background: 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.
Methods: 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.
Results: 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.
Conclusion: 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.
Competing Interests: Declaration of competing interest The authors declare that there is no competing interest.
(Copyright © 2024 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: