A Research On The Resource Allocation Efficiency Of Medical And Health Fiscal Expenditure In Cities Under The Public Hospital Reform

Promoting the pilot reform of public hospitals as one of the key contents of the "Opinions on Deepening the Reform of the Medical and Health System" is an important task and breakthrough for deepening the reform of the medical and health system.The level of basic medical care is related to the national economy and people’s livelihood,determines the quality of people’s lives,and further affects social development.The report of the 19 th National Congress of the Communist Party of China clearly pointed out that socialism with Chinese characteristics has entered a new era.The main contradictions in society have been transformed into the contradictions between the people’s increasing needs for a better life and imbalanced and inadequate development.The contradiction between increased medical and health needs and the slow development of medical and health services in China.Medical and health resources have the attributes of public products.The government needs to play an important role in the provision of medical and health care.It cannot be absent.It needs to strengthen its own medical and health services and management functions.Although the government’s fiscal expenditure has increased rapidly and the fiscal expenditure for medical care has also increased year by year,the proportion of medical expenditures in total expenditures is low,and people’s satisfaction with the medical services provided by the government is still low.According to the latest data from the National Bureau of Statistics,from 2009 to 2017,the proportion of national health expenditures in public health expenditures increased relatively slowly,with an average annual growth rate of only 3.91%.In 2017,the proportion of Chinese government health expenditures to total health expenditures was 30.1%,Which is only half of the world average in that year;Problems such as large regional differences in health resources,poor medical services.excessive medical treatment,high medical costs,and low feedback on policy implementation affect people’s satisfaction with medical services.The mismatch between the increase in health care fiscal expenditure and the output effect makes it necessary to examine the actual level and output effect of health care fiscal expenditure in the first batch of pilot cities and non-pilot cities in the reform of public hospitals,as well as the effect of this reform on the pilot and Impact of resource allocation efficiency on health expenditure in non-pilot cities.Therefore,this paper first analyzes the transmission path of the impact of public hospital reform on the efficiency of medical and health fiscal expenditure resource allocation by combing the basic theory and the efficiency of public hospital reform on the allocation of medical and health fiscal expenditure resources in the first pilot cities and non-pilot cities from a theoretical and practical perspective.Secondly,construct an input-output analysis framework,and use data envelopment analysis(DEA)to measure the efficiency of resource allocation for medical and health expenditures in 41 pilot and non-pilot cities between 2005 and 2015;again,use 2005-Based on 11-year panel data of 41 prefecture-level cities in China in 2015,based on the measured efficiency of resource allocation for medical and health expenditures measured by DEA,from the perspective of the policies of the first batch of public hospital reform pilot cities,a empirical study of public hospitals was made using a dual difference model The impact of reforming the policy of the pilot cities on the efficiency of the allocation of resources for medical and health expenditures has resulted in corresponding results and passed the robustness test.The results of the double-difference study show that: the reform of public hospitals has a significant positive impact on the overall technical efficiency and scale efficiency of the allocation of medical and fiscal expenditures in the pilot cities,indicating that the reform of public hospitals has significantly improved the efficiency of the allocation of medical and fiscal expenditure resources;The hospital reform pilot city policy also has a significant positive effect on the overall technical efficiency and scale efficiency of the allocation of medical and fiscal expenditures in time,indicating that the efficiency of medical and fiscal expenditures has achieved good results during the policy implementation period;the model passed The parallel trend test was used,but under the public hospital reform,the significant impact of the efficiency of the allocation of health care fiscal expenditure resources did not last for a long time,and it resumed as usual after two or three years,that is,the policy effect has a decreasing trend and the significance duration is not very long.Therefore,it is necessary to steadily increase the government’s investment in prefecture-level medical and health fiscal expenditures,optimize its structure,and ensure the sustainability of public hospital reform policy effects in terms of institutions and mechanisms.Finally,in view of the empirical problems,this article puts forward relevant suggestions to improve the efficiency of the allocation of health care fiscal expenditure resources.First,improve the performance management mechanism of health care fiscal funds and improve the planning capacity of health care resources;Fiscal investment,encourage and guide social capital to participate in it,and establish a scientific and effective pluralistic compensation subject;third,improve the quality and capabilities of medical human resources,Focus on the application of innovation in science,and help the durability of policy effects;fourth,continue to deepen public hospital Reform and improve the supervision system of medical expenditures in prefecture-level cities.