Key result
China's NEPHSP is linked to ~CNY 714 lower annual medical costs for hypertension and diabetes.
Why the study?
HTN and T2DM impose a substantial economic burden in China, but evidence regarding the economic impact of the National Essential Public Health Service Package (NEPHSP) is scarce.
Does management under the National Essential Public Health Service Package reduce medical costs in patients with hypertension or type-2 diabetes?
Cohort (n=5,456,854)
Yes
Does management under the National Essential Public Health Service Package reduce medical costs in patients with hypertension or type-2 diabetes?
p-value: p=<0.001
Community-based public health management of hypertension and type-2 diabetes through China's NEPHSP is associated with substantial medical cost savings, supporting policies prioritizing prevention.
Hypertension (HTN) and type-2 diabetes mellitus (T2DM) present a substantial economic burden of disease in China. The National Essential Public Health Service Package (NEPHSP) is a Chinese government initiative to provide a suite of basic public health services to all residents for free, with the aim to shift the focus of the healthcare system towards prevention and community-based primary health care. However, evidence is scarce regarding its economic impact. A retrospective, province-wide study was designed to extract 5,456,854 electronic medical records from 339 institutions in Henan province from January 1, 2022 to December 31, 2024, using stratified cluster sampling. Patients with HTN or T2DM managed under the NEPHSP were identified by linking medical records to the NEPHSP management registry. Based on the International Health Partnership + (IHP +) common monitoring and evaluation (M&E) framework, we assessed medical costs as the primary outcome. Propensity score matching was used to create comparable cohorts of NEPHSP-managed and non-managed patients. The difference in mean annual total medical costs per capita was analysed using a two-sample Z-test. NEPHSP-managed patients had lower mean annual total medical costs across all years for both HTN and T2DM, with the largest cost difference observed in 2023 (up to CNY 713.57). When stratified by types of medical costs, we found NEPHSP-managed patients had lower average costs for general medical services, diagnostics, treatment, and western medicine compared to non-managed patients. The cost savings associated with NEPHSP-managed were most pronounced in males, older patients (≥ 65 years), and those with three or more comorbidities. Community-based public health management of HTN and T2DM through China’s NEPHSP is associated with substantial medical cost savings, particularly for high-risk demographic groups. Our findings provide real-world evidence supporting national policies that prioritise prevention and community health services. Continued investment in NEPHSP is a highly effective strategy for mitigating the economic burden of chronic disease in China and similar settings.
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Liu et al. (2026) conducted a cohort in Hypertension and type-2 diabetes mellitus (n=5,456,854). National Essential Public Health Service Package (NEPHSP) vs. Non-managed care was evaluated on Mean annual total medical costs per capita (p=<0.001). China's National Essential Public Health Service Package reduced mean annual total medical costs for patients with hypertension and type-2 diabetes, with savings up to CNY 713.57 per capita.
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