Research On Spatial Distribution And Equity Of Chinese Government Health Expenditure

The healthcare reform in China is a reform that balances the relationship between government’s leading roles with the market mechanism.In this regards,it is a common concern for the Chinese government and its people as to how government health investment play its role in social redistribution more effectively as a public financial behavior,so as to reduce social inequality and ensure people’s livelihood.Under the current health system in China,the scale and structure of government health expenditure directly influence the service delivery,financial operation and business development of public health service providers.It also affects the distribution of healthcare resources between urban and rural areas,between different regions and between health providers of different types and at different levels,then affect the access to and equity in health service for people,and people’s health and social justice ultimately.Nowadays,the government health expenditure is facing new challenges posed by the pursuit of ambitious goals in maintaining and promoting the people’s health,the implementation of healthcare reform and the construction of Healthy China,as well as the new normal in economic and social development.Since the new round of healthcare reform,China’s medical and health undertakings have made outstanding achievements,and the people’s health level has been improving.However,the problem on the disparity in health expenditure between regions and between urban and rural areas is still serious,due to factors such as unbalanced economic development level and various health input policies.The problem of “kan bing nan,kan bing gui”(getting medical care is difficult and expensive)for people still exists.Therefore,to understand the spatial distribution of government health expenditure accurately and analyze its problems and causes objectively is of great significance for optimizing the allocation of healthcare resources,promoting the coordinated healthcare development among regions,and further pushing forward the construction of Healthy China.This paper firstly used literature study to define the concepts,scopes and measures for government health expenditure,its spatial distribution,and its equity.It also conducted theoretical study in theoretical basis,necessity and functions of government health expenditure,and analyzed the impact of institution on the spatial equity of government health expenditure through theory study and econometric models.Secondly,this paper systematically reviewed and assessed the development of policies on the spatial distribution of government health expenditure.It used data on economic development,demographics,health needs,and government health expenditure at provincial level to examine and assess the current spatial distribution of social and economic development,health needs as well as government health expenditure among 31 provinces and among regions.Based on the above study,Concentration Index Method and the Kendall Coherence Coefficient Method were used to study the equity of government health expenditure and health outcomes among regions.The paper conducted an econometric study.In the model,it used the index of health fiscal expenditure which is measured based on health needs as a dependent variable to reflect the division of financial power and responsibility between the central and local governments.It used level and intensity of essential public health expenditure and the basic medical insurance for urban and rural residents(including Basic Medical Insurance for Urban residents and new Rural Cooperative Medical Schemes)as the independent variable indicators.Through this model,it analyzed the impact of local financial authority’s responsibility,and inclusive or supportive finance arrangement on the spatial distribution of government health expenditure.It conducted the empirical study from the perspective of institutional structure to examine the factors that influence the spatial distribution and equity of government heath expenditure.Based on empirical findings,it put forward relevant suggestions for promoting the equity of the spatial distribution of government health expenditure,and provided evidence for decision-making in the allocation of government health expenditure,so as to deepen the process of medical reform and promote the sustainable development of health understandings in China.Findings: In recent years,government health expenditure has been continuously increasing in the scale,while the overall growth rate has declined.The share of government health expenditure in total health expenditure is less than 30% for more than half of 31 provinces in China,which means the governments fail to play a leading role in the development of health undertakings.The spatial disparity of government health expenditure is large,and inequity is serious,which influence the efficiency of allocation and operation of government health expenditure seriously and reduce its outputs and benefits.In terms of the impact of institutional structure on the spatial distribution of government health expenditure in China,the improvement of local financial level,the "supportive" transfer payment project of central finance and the intensity and level of government health expenditure are conducive to improving the fairness of the spatial distribution of regional government health expenditure.To improve the equity in the spatial distribution of the government health expenditure across the country,the paper has proposed the following suggestions: improve the institutional systems and structures to ensure the equity;strengthen the construction of relevant laws and regulations to provide legal protection;further strengthen the equitable top-level design and development plan for regional health funding,and increase policy support for related fiscal,health care and consumption policies;promote the monitoring and information release mechanism on the spatial distribution of regional health funds;the assessment of spatial allocation equity should be included in the performance assessment of government health expenditure.