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.　©　2023　The　Authors