Research On The Impact Of Fiscal Decentralization On The Allocation Efficiency Of My Country’s Basic Public Health Services ——Analysis Based On 2008-2018 Provincial Panel Data

In recent years,with the spread of various infectious viruses,major tests and higher requirements have been put forward on the quality of our country’s public health services.As the institutional factors behind the supply of public health services,domestic and foreign scholars have also studied the impact of fiscal decentralization on the supply of public health services,and their conclusions are also different.Some scholars’views are in line with the traditional theory of fiscal decentralization.They believe that the increase in fiscal decentralization enables local governments that are more aware of local residents’ needs and preferences to provide high-quality public health services in response to public expectations.that is,the provision of public health services is effective.At the same time,some scholars have concluded that the opposite is true.They believe that the increase in fiscal decentralization is not conducive to the supply of public health services,that is,the supply of public health services is ineffective.However,at present,there is no relatively uniform standard and method for characterizing the effectiveness and rationality of public service supply.Most scholars judge its impact on the efficiency of public service supply based on the positive or negative of the estimated coefficient of fiscal decentralization.And this article believes that this judgment method often ignores that the goal of the government to provide public services is the public benefit,that is,whether the public’s expectations and needs for public services are met.Based on this,this article takes public health services as the object,focuses on the process from the output of public health services to the benefits of residents,takes the needs of residents as the starting point,and further explores and studies the impact of fiscal decentralization on the efficiency of public health service allocation,that is,fiscal distribution.The issue of the rationality and matching between the output of public health service and the needs of residents provides a feasible way for the characterization of public health service efficiency from a new perspective.Based on theoretical analysis,this paper derives the optimal allocation efficiency conditions of public health services based on Lindahl’s equilibrium and Samuelson’s conditions,and proposes whether fiscal decentralization has a positive or negative effect on the allocation efficiency of public health services based on the two-generation fiscal decentralization theory.Two assumptions about the impact.Then through empirical analysis,based on the 2008-2018 provincial panel data,by constructing a resident benefit function and combining it with the allocation efficiency function,and the most common indicators for measuring the degree of fiscal decentralization-expenditure decentralization and income decentralization are obtained respectively.The allocation efficiency value of public health services in each province is analyzed,and the sign and size of the estimated parameters are analyzed,and the impact of fiscal decentralization on the allocation efficiency of public health services is explored from the national perspective and the perspective of the eastern,central and western regions.Through empirical testing,the main conclusions are as follows:First,all provinces in China do not meet the conditions of optimal public health service allocation efficiency,and the allocation efficiency varies greatly among provinces.From the perspective of east,middle and west regions,its allocation efficiency is greater in the east than in the middle and in the west;Second,the coefficients of expenditure decentralization and income decentralization in the estimation results are both negative and significant,no matter from the perspective of the whole country or the three regions of east,middle and west.This means that Chinese fiscal decentralization has a reverse inhibitory effect on the efficiency of public health service allocation,which verifies Hypothesis 2;Third,in terms of different regions,the estimated coefficient of fiscal decentralization in the western region is significantly negative,and its absolute value is greater than that in the eastern region.That is,the level of the negative effect of fiscal decentralization on the western region is greater than the negative effect of the eastern region;Fourth,the absolute value of the estimated coefficient of fiscal decentralization under expenditure decentralization is greater than the absolute value of the estimated coefficient under income decentralization,that is,the transfer payment of the central government does not significantly promote the efficiency of public health service allocation.In the part of policy recommendations,First,laws should be formulated to clarify the division of responsibilities between the central and local governments regarding public health services,and by improving the local tax system to define the revenue division between the central and local governments to accelerate the reform of the fiscal and taxation system,thereby fundamentally improving the efficiency of public health service allocation;Secondly,establish a multi-level,multi-subject,and multi-channel official performance evaluation system,optimize the performance evaluation method,and force the government to optimize the efficiency of public health services by realizing the role of performance evaluation;Finally,improve the transfer payment system,strengthen the supervision and management of transfer payments,truly realize information transparency supervision and management,and ensure the implementation of funds to improve the efficiency of fund use.