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The impact of increasing expenditure on National Essential Public Health Services on the medical costs of hypertension in China: A difference-in-difference analysis

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Listed:
  • Long Xue
  • Mengyun Sui
  • YunZhen He
  • Hongzheng Li
  • Xiaohua Ying

Abstract

Background: The prevention and control of hypertension should be an effective way to reduce deaths and it has been a high priority in China. In 2013, the Chinese government increased the subsidy standard for the National Essential Public Health Services Package (NEPHSP) from RMB 15 to RMB 30 per person, which was expected to cover 70 million hypertensions. This study explored the influence of increasing NEPHSP subsidy 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 study sample included 3192 hypertensive patients who were not lost to follow-up from 2011 to 2015. Hypertensive patients who covered by NEPHSP from 2011 to 2015 were defined as the treatment group, otherwise defined as the comparison group. The policy intervention was the increase of NEPHSP subsidy in 2013, and the years before and after 2013 were respectively considered as pre- (2011) and post-intervention (2015). The primary outcomes variables were the outpatient and inpatient expenditure of patients with hypertension, based on direct spending of outpatients and inpatients separately reported by patients with hypertension. Using propensity score matching (PSM) to match the individual characteristics of hypertension in the treatment group and the comparison group, difference-in-differences (DID) were used to analyze the outcomes. Results: The patients with hypertension’ outpatient and inpatient expenditure patterns in the treatment and control group show an increasing trend from 2011 to 2015. After PSM, of the 1 956 hypertensive participants, 369 covered by the NEPHSP before and after 2013. A DID estimate of the increased NEPHSP subsidy was associated with a significant decrease of 1 251.35 RMB (t = 2.13, P = 0.034) in hypertension related inpatient expenditure, no significant change (t = 0.61, P = 0.544) among outpatient expenditure. Conclusions: The NEPHSP may reduce inpatient expenditure among hypertension. Further strengthening of the NEPHSP may reduce their burden.

Suggested Citation

  • Long Xue & Mengyun Sui & YunZhen He & Hongzheng Li & Xiaohua Ying, 2022. "The impact of increasing expenditure on National Essential Public Health Services on the medical costs of hypertension in China: A difference-in-difference analysis," PLOS ONE, Public Library of Science, vol. 17(11), pages 1-14, November.
    • Handle: RePEc:plo:pone00:0278026
    DOI: 10.1371/journal.pone.0278026
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    References listed on IDEAS

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    1. Marco Caliendo & Sabine Kopeinig, 2008. "Some Practical Guidance For The Implementation Of Propensity Score Matching," Journal of Economic Surveys, Wiley Blackwell, vol. 22(1), pages 31-72, February.
    2. Karan, Anup & Yip, Winnie & Mahal, Ajay, 2017. "Extending health insurance to the poor in India: An impact evaluation of Rashtriya Swasthya Bima Yojana on out of pocket spending for healthcare," Social Science & Medicine, Elsevier, vol. 181(C), pages 83-92.
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