Evaluating the Impact of National Essential Public Health Services Program Coverage on Hypertension Management, Medical Care Utilization and Household Socioeconomic Well-Being.

Background: Launched in 2009, China's National Essential Public Health Services Program (NEPHSP) has been broadly implemented throughout the country. However, rigorous evaluations of its impact on chronic disease outcomes remain limited. Hypertension, being one of the major noncommunicable diseases targeted by the program, provides an important case study for assessing its effectiveness. Methods: We used longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018 to evaluate the impact of receiving NEPHSP-covered services (from 2015 onward) on hypertension management. A difference-in-difference approach with two-way fixed effects was used on a cohort of 774 hypertensive adults to estimate changes in health and socioeconomic outcomes associated with NEPHSP coverage. Results: NEPHSP participation contributed to significant increases in hypertension control (9.8%; 95% CI: 2.7-16.9%; p<0.01) and treatment rates (9.9%; 95% CI: 3.8-16.1%; p<0.01). It also increased inpatient admissions by 0.17 per year (95% CI: 0.03-0.31; p<0.05). No significant effect was found on outpatient visits. In addition to clinical benefits, involvement in NEPHSP was linked to a 5.4% reduction in the Engel coefficient (95% CI: 1.2-9.6%; p<0.05), indicating improved household economic well-being. These impacts were more pronounced among younger adults and urban residents, highlighting disparities across subpopulations. Conclusion: The findings provide evidence that NEPHSP has improved hypertension management and household economic well-being. To further maximize these gains, future policy refinements should focus on adapting services to the specific needs of older age groups and other less-responsive subpopulations to ensure universal health equity.