Research On The Impact Of Fiscal Decentralization On The Efficiency Of Public Health Expenditure

The Healthy China Strategy is the focus of the report of the 19 th National Congress of the CPC,and it is also an inevitable requirement for protecting and improving people’s livelihood.To achieve a healthy China,it is necessary to provide a sound public health service system.Good public health services are conducive to promoting social equity,forming a good social order,and making people feel more secure and happy.However,the sound development of the economy since the reform and opening up has not led to the improvement of public health services.In the past,simply increasing the scale of public health expenditure did not meet the growing public health service needs of the people in the new era.Therefore,it is necessary to improve the efficiency of public health expenditure.With the reform of the fiscal system since the "tax reform",we need to consider how to improve the efficiency of public health expenditure in the context of limited financial resources.This article explores the impact of fiscal decentralization on the efficiency of public health expenditure from the perspective of the fiscal system,and proposes relevant policy recommendations to improve the efficiency of public health expenditure.This article explores the impact of fiscal decentralization on the efficiency of public health expenditure in four main sections:First,the concepts and theoretical basis of fiscal decentralization and public health expenditure efficiency were reviewed,and the analytical framework of this paper was established.First,the basic concepts of fiscal decentralization and public health efficiency are defined,the current status of fiscal decentralization is explained,and the basic measures and influencing factors of public health expenditure efficiency are briefly introduced.Then analyze the mechanism that affects the efficiency of public health expenditure from the perspective of fiscal revenue decentralization and fiscal expenditure decentralization.The second is a detailed explanation of the history and current situation of fiscal decentralization reform.At the same time,it analyzes the current public health expenditure status from the differences in scale and structure,and finally points out the main problems of current public health expenditure.The main problems of current public health expenditure are insufficient public health expenditure and irrational expenditure structure.The third is to use the DEA method to measure the relative technical efficiency,technological progress,pure technical efficiency,and scale efficiency of public health expenditure in each province,and explain the trend of public health expenditure efficiency in each province in the past decade.Because the local government bears the main responsibility for public health expenditure,the level and proportion of public health expenditure in the central and western regions are significantly lower than in the eastern region,and the efficiency of public health expenditure is also lower than in the eastern region.Constant concentration has resulted in inefficient overall spending.Under the TOBIT panel model with restricted dependent variables,the panel data of 31 provinces(municipalities)from 2008 to 2017 were used to focus on the impact of fiscal decentralization on public health expenditure efficiency.Empirical results show that both decentralization of fiscal revenue and decentralization of expenditure are not conducive to the improvement of public health expenditure efficiency,and have different effects on fiscal revenue decentralization and fiscal expenditure decentralization in the eastern,central and western regions.The fourth is to draw conclusions based on the results of Part III: Fiscal decentralization is not conducive to improving the efficiency of public health expenditure and put forward relevant policy recommendations.This includes continuously deepening the reform of the decentralization system,improving the transfer payment system,adjusting the promotion evaluation mechanism for officials,and improving the structure and scale of public health expenditure...