The Economic Impact of National Essential Public Health Service Package for Hypertension and Type-2 Diabetes: A Retrospective Province-wide Study in China

Background 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. Methods 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. Results 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. Conclusions 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.