Fiscal Decentralization, Expenditure Preference And Local Government Health Expenditure Efficiency

The report of the 19 th National Congress of the Communist Party of China clearly pointed out that the major contradiction in our society has been transformed into the contradiction between the people's growing need for a better life and the unbalanced and inadequate development.From the perspective of health care,the people's health needs are growing and upgrading with the development of social economy.However,problems such as insufficient total health resources,unreasonable structure,uneven distribution,relatively single supply entities,and weak grassroots service capabilities are still outstanding.The reform has entered the deep-water zone and the tackling period.It is impossible to simply expand the government's investment scale to meet the growing and escalating health needs of the people.It is necessary to shift the focus of the policy to the effectiveness of government health expenditure.From the perspective of public finance,the government's investment in health care,that is,government health expenditure,is part of public finance expenditure,government health expenditure is part of the state's fiscal expenditure,and government health expenditure efficiency is closely related to the national macro-financial system.Under the macro background of China's fiscal decentralization system and the establishment of modern fiscal system,it is of great theoretical and practical significance to explore the relationship between fiscal decentralization and local government health expenditure efficiency.In addition,considering the implementation of the new medical reform,the government has gradually increased investment in basic medical insurance,trying to reduce waste and optimize the allocation of health resources by establishing a strong supplier market,but the actual results have not been fully verified.The purpose of this paper is to explore the impact of fiscal decentralization and the demand-side preference of government health expenditure on the efficiency of local government health expenditure,and to provide policy recommendations for further improving the efficiency of government health expenditure.First of all,this paper clarifies the background and significance of the research,and introduces the domestic and foreign research review,research thinking and framework,research innovation and deficiencies,related concepts and theoretical foundation.Secondly,this paper conducts a general analysis of government health expenditures.On the one hand,it sorts out the government's health investment policy since the founding of the People's Republic of China and clarifies the three stages of the government's health investment system.On the other hand,horizontal and vertical comparison of the scale and structure of government health expenditures over the past decade has been made to clarify the current status and trends of government health expenditures.After that,the data envelopment analysis method is used to calculate the comprehensive efficiency,pure technical efficiency and scale efficiency of the 31 provincial(municipal)government health expenditures from 2009 to 2017.Through horizontal and vertical comparison and static comprehensive analysis,the trends of the health expenditure efficiency of local governments in the past decade and their main influencing factors are revealed.Based on that,using panel data to carry out Tobit regression analysis,focusing on the impact of fiscal decentralization and the demand-side preference of government health expenditure on the efficiency of local government health expenditure,and puts forward policy recommendations to improve the efficiency of government health expenditure.Through theoretical research and empirical analysis,the following conclusions are drawn.First,the comprehensive efficiency level of local government health expenditure has gradually increased,however,local government health expenditure still has a certain degree of scale invalidity,and the mismatch between supply and demand leads to the coexistence of input redundancy and insufficient output.In brief,the efficiency of local government health expenditure needs to be further improved.Second,fiscal decentralization has a significant positive impact on the efficiency of local government health expenditure,improving the education level of residents and the level of economic development are conducive to promoting the efficiency of local government health expenditure,and the excessive population density results in the loss of the health expenditure efficiency of local governments.Third,under the condition that the market mechanism and the supervision mechanism of medical and health service are imperfect,the demand-side preference of government health expenditure and raising government health financing responsibilities are not conducive to the improvement of government health expenditure efficiency.Based on the research conclusions,the following suggestions for improving the efficiency of government health expenditure are proposed.First,clarify the positioning of government health functions and the boundary of government expenditure responsibility.Second,establish and improve the modern fiscal system,and clarify the division of health affairs between the central and local governments.Third,scientifically design an incentive compatibility mechanism to strengthen the dynamic supervision of health expenditures.Fourth,adjust and optimize the structure of health expenditures,and improve the medical service market system.Fifth,deepen the reform of the medical and health system,and optimize the allocation of resources through collaboration across multiple domains.