Fiscal Decentralization At Sub-provincial Level And The Efficiency Of Government Health Expenditure ——A Case Study Of 34 Cities In The Northeast

The 14 th Five-Year Plan and the vision for 2035 emphasize the strategic priority of ensuring people’s health.Medical and health care is an important cause to ensure people’s health,while public finance is an important guarantee for people’s livelihood.In recent years,the financial expenditure on medical and health care in the three northeastern provinces has increased steadily,and remarkable achievements have been made in the development of health care.At the same time,it should be realized that the transformation of the main social contradiction makes the people have higher requirements for health quality and service level,while the downward pressure of the macro economy makes the growth of fiscal revenue weak,and the investment of financial resources in the medical and health field faces greater constraints.In addition,the aging process in the three northeastern provinces has accelerated,which has increased the burden of medical and physical health departments.How to bring the limited financial health input into full play,improve the quality and efficiency of financial health input,so as to relieve financial pressure,meet people’s demand for a better life,and promote the healthy development of Northeast China has become an important topic for the three eastern provinces to consider during the "fourteenth Five-year Plan" period.Firstly,on the premise of sorting out relevant literature and defining concepts,this paper clarifies the theoretical foundations of fiscal decentralization theory,fiscal efficiency theory,and public goods theory related to research,and expounds the mechanism of how fiscal decentralization below the province affects the efficiency of government health spending.Secondly,the reform process of the financial system below the provincial level in Northeast China is sorted out,and its development time track,reform route,key time nodes and specific rules are summarized.At provincial and municipal levels,the paper analyzes the decentralization status at provincial level with multiple indicators.Thirdly,the traditional CCR model,BCC model,super efficiency model and MALMQUIST index method are used to comprehensively and scientifically measure and evaluate the health expenditure efficiency of 34 municipal governments in northeast China.Then,the relationship between fiscal decentralization at the provincial level and the efficiency of government health expenditure is empirically tested,and the relationship between fiscal decentralization at the provincial level and the efficiency of government health expenditure is baseline regression by using the fixed effect model.Panel Tobit model and system GMM model were used to test the robustness.The relationship between them was further discussed through the time segment regression and quantile regression.Then the problems and causes were analyzed,and it was found that there were obvious regional differences,most cities failed to realize DEA effectiveness,total factor productivity declined,and decentralization system below provincial level inhibited the improvement of government health expenditure efficiency.The reason is that the distribution of health resources in northeast China is not balanced,the structure of health expenditure is not reasonable,and the finance below the provincial level is not balanced.Finally,some policy suggestions are put forward,such as perfecting the fiscal decentralization system below the provincial level,improving the budget management level of government health expenditure,deepening the reform of medical and health system and increasing the synergy of various parties outside the system.