| People’s health is the foundation for a nation and is crucial to the development of society and economy.Basic medical and health services are an important basis for improving people’s health,ensuring and improving people’s livelihood,and promoting social harmony.Since the 18 th National Congress of the Communist Party of China,China has made remarkable achievements in medical and health undertakings.The level of medical and health services has been significantly improved and the government health expenditure has continued to grow.During the 13 th Five-Year Plan period,the annual growth rate of the government health expenditure is 7.5%.The 19 th National Congress stressed the need to ensure high-quality provision for people’s lives through high-quality development and continue to raise people’s sense of fulfillment and happiness.The Basic Medical and Health Promotion Law of the People’s Republic of China issued in December 2019 further emphasizes that the government should increase its input in the medical and health sector,optimize the allocation of medical and health resources,and ensure that all residents enjoy basic medical and health services.With the development of economy and the improvement of people’s living standard,residents’ demand for health is constantly increasing,and the demand for high-quality public medical and health conditions is also increasingly strong.Meanwhile,medical and health services are still difficult and expensive,which requires the government to further play its leading role in the medical and health sector and optimize the production and allocation of medical and health resources.The outbreak of the COVID-19 epidemic in 2020 not only verified the emergency response management level of China’s medical and health system,but also caused a wide range of debates and reflections on the adequacy and effectiveness of China’s government health expenditure.Given the above background,this paper not only give a comprehensive analysis of the specific situation of China’s fiscal health care expenditure,but also evaluates and analyzes China’s government health expenditure from the perspectives of economic growth and residents’ happiness.It will provide theoretical support and countermeasures for China’s future government medical and health policies.Based on methods such as the data envelopment method,individual relative deprivation index and spatial measurement method,this paper investigates the actual situation of the government’s health expenditure from the perspective of the scale,structure,efficiency and equity respectively.The socioeconomic effect of government health expenditure is investigated from both macro and micro level.The empirical results show that:(1)The relative scale and sustainability of government health expenditure are insufficient,and the structure of government health expenditure needs to be optimized urgently.(2)There is a big space for the improvement of China’s government health expenditure efficiency,and there exists obvious differences between regions’ and provinces’ government health expenditure efficiency;at the same time,the space effect of government health expenditure efficiency is evident,meanwhile rates of fiscal decentralization,the urban basic medical insurance and other social economic factors significantly affect the efficiency of government health expenditure.(3)The exists prominent inequality of inter-provincial government health expenditure;the absolute gap continues to expand,the relative gap gradually decreases;and there is a big difference in the growth rate,and the trend of horizontal centralization decreases.At the same time,there is a relatively obvious spatial effect on the equity of interprovincial government’s medical and health expenditure.Moreover,factors such as local financial resources and local resource allocation will have a significant impact on the equity of government health expenditure.(4)In addition to the government health expenditure structure of “grassroots” indicators,the government health expenditure scale,structure,efficiency and equity are significant promoting effect on economic growth;the government health expenditure could affect economic growth by human capital accumulation,labor productivity and labor participation rate.At the same time,there is a threshold effect on the impact of government health expenditure on economic growth;There is heterogeneity among the impact of the scale,structure,efficiency and equity of government health expenditure on the economic growth of provinces with different levels of economic development.(5)The scale and efficiency of government spending on health care have a significant promoting effect on residents’ happiness;from the perspective of expenditure structure,“strengthening community-level medical services” has a positive effect on residents’ happiness,while “supplementing the demand” has a negative effect on residents’ happiness;there is an “inverted U-shaped”relationship between the equity of government health expenditure and residents’ happiness;meanwhile,income stratification,household registration stratification and regional stratification are the important factors that affect the happiness effect of government health expenditure,and government health expenditure has a positive impact on residents’ happiness by residents’ sense of access to medical and health service,sense of social equity and disposable income.The main innovations and contributions of this paper are as follows:(1)This paper comprehensively investigates the actual allocation and use of government health expenditure from the four perspectives of expenditure scale,structure,efficiency and equity,and discusses the influence factors of government health expenditure efficiency and equity,and to conduct analysis and test with a variety of empirical methods.Finally,the analysis framework of the governments’ health expenditure is broadened by focusing on the economic growth and residents’ happiness which are the two most concerned issues of the government and society.(2)When measuring the efficiency of government medical and health expenditure,the direct and indirect outputs of government medical and health expenditure are also paid attention to,and output indicators are selected from three aspects: medical and health resources,medical and health services and health output.(3)The spatial econometric model is used to analyze the influence factors of the efficiency and equity of Chinese government health expenditure,and the external spillover effect and spatial correlation of government health expenditure are taken into account to make the results more scientific.(4)This paper regard government health expenditure as a kind of investment of human capital production and social reproduction to study the effect of government health expenditure on economic growth from the perspective of health human capital which are different from previous research angle of view;and discusses the influencing mechanism of government health expenditure on economic growth by mediating effect model which enriches and expands the research in related fields.(5)Based on the multi-level structure model of subjective well-being,this paper choose indexes from four perspectives of overall subjective well-being,life satisfaction,positive emotions and negative emotions,six variables of life satisfaction,depression,sadness,feeling happy,happy life and cognitive happiness to measure residents’ happiness.It is a supplement to the earlier research literature that only relied on self-evaluation index to measure subjective wellbeing. |
