Fiscal Decentralization And Local Government Health Expenditure Efficiency Research

With the advancement of medical and health reforming,the scale of local government medical and health expenditure has risen rapidly.Most scholars have shown that the efficiency of medical and health expenditure in China needs to be improved ? On the other hand,the influence of Industrialization,urbanization,population aging and so on enhance the level of people's health care needs,but the decline in China's economic growth and to replace the business tax with a value-added tax led to the reduction of fiscal revenue,restricting the government to improve the financial investment to meet people's needs for health care.In order to meet the needs of the people for medical and health care,it is particularly important to explore how to improve the efficiency of medical expenditure under the limited financial resources.This paper first introduces background and significance of the research,summary at home and abroad,the ideas and framework and so on.Secondly,it introduces the connotation and the related theory of the efficiency of the local government's medical and health expenditure.Then followed by analysing the medical and health expenditure situation under the Chinese fiscal decentralization system.Then using DEA-Malmquist index analysis to measure the relative technical efficiency,technological progress,pure technical efficiency and scale efficiency of medical and health expenditure in each province,and to explain the main factors influencing the change trend and change of medical and health expenditure efficiency in the past ten years.Then using the panel data from 2007 to 2015 for 31 provinces to study the impact of decentralization and transfer payments on the efficiency of local government health expenditure under the fiscal decentralization system.Finally,the corresponding policy recommendations were put forward.The main conclusions are drawn from study: First,the local government medical and health expenditure between urban and rural structure is unreasonable.Second,the overall level of local government health expenditure efficiency is declining,and there is a certain regional difference,the main reason of decline of efficiency is the decrease of technological development.Third,the China's local government health care expenditure is in the stage of decreasing scale,but the provinces are different,the provinces should according to their own situation to adjust the scale of investment.Fourth,the fiscal expenditure decentralization and fiscal revenue decentralization aresignificantly unfavorable of the increase in the efficiency of local government health care expenditure,transfer payments significantly contributed to the improvement of expenditure efficiency.In addition,the improvement of the level of opening up is not conducive to the increase of the expenditure efficiency,and accelerating the level of local economic development,improving local revenue and increasing the density of local population can promote local government health care expenditure efficiency.On the basis of this,the author puts forward the measures to improve local government health expenditure efficiency.Such as Improve China's financial system,optimize the structure of urban and rural health care expenditure,pay attention to scientific and technological innovation and reasonable adjustment of expenditure scale,build local government health expenditure assessment index system and improve the supervision mechanism.