Improved air quality from China's clean air actions alleviates health expenditure inequality

Clean air actions aimed at improving air quality in China have brought about significant health benefits, thereby generating substantial savings in air-pollution-related healthcare spending. Yet, uneven regional air quality improvements and economic developments may alter existing inequality in health expenditures in the context of scarce healthcare resources. Here, we developed an econometric model that resolves individual characteristics at the city level to examine the disparity of public health expenditures in air quality improvements across regions differing in economic development and healthcare coverages and projected a range of future health expenditure savings under different air quality targets. We find that of the estimation on four air-pollution-related diseases (COPD, LRI, IHD, and stroke) in 98 cities over the year 2015-2017, a decline of 8.26 % in average hospitalization days and 10.21 % in hospitalization expenses was achieved, leading to a reduction of 8.09 % in total health expenditures as the implementation of clean air actions. Improved air quality has declined health expenditure inequality in low-middle cities and cities with imbalanced healthcare coverage. For example, the total expenses for the four diseases declined significantly in the low (-11.31 %) and medium (-7.34 %) per capita GDP groups, as well as a remarkable decline in the fewer medical resources. Health savings in some future scenarios are significant, showing substantial health expenditure savings under different air quality targets, but the savings will be greatly offset by an aging society. For example, In the Low-Level Improvement Pathway of air quality targets with aging (LLIPA scenario), health expenditure savings will be about 3537, 464, and 311 million CNY in the eastern, central, and western regions in 2035, respectively. Our findings thus highlight the importance of strengthening air pollution control policies and considering the equality of alleviating regional public health costs.