Research On The Efficiency Of Government Medical And Health Expenditure In China

Medical and health services,as a basic need for people’s livelihood,have always been a key topic of concern for the state and the people.Since the implementation of the new medical reform in 2009,the state has always attached importance to the development of the medical and health field,and the scale of the government’s medical and health expenditure has been increasing year by year.In recent years,the strategy of "Healthy China" proposed by The 19 th National Congress of the CPC and in the "six guarantees" task proposed by 2020,ensuring basic livelihood is the second,which shows the government attaches great importance to the health of the people.Meanwhile,the Chinese fiscal decentralization system and the policy of cut taxes and administrative fees has made local governments bear huge expenditure pressure.The COVID-19 outbreak in Wuhan at the end of December 2019 was another major public health emergency in China following the SARS virus in 2003,which had a serious adverse impact on China’s economic development and people’s lives.Combined with the current policies and the background of the epidemic,China’s government’s medical and health expenditure need to be further improved and optimized.Therefore,it is of great significance to deeply explore the efficiency of Chinese government’s medical and health expenditure.The purpose of this study is to measure the efficiency of government medical and health expenditure and analyze the influencing factors,then put forward some suggestions for efficiency improvement under the current economic and epidemic background.Starting with domestic and foreign literature,this paper firstly analyzes and sorts out the content of government health expenditure and efficiency,and then based on public product theory,the theory of fiscal decentralization,principal-agent theory and new public management theory,and the theoretical analysis of the system,economy and society three external environment factors on the efficiency of the government health care spending.Second,analysing the scale,structure and output of our government health expenditure,then build the government health expenditure efficiency evaluation index.Using SE-SBM model and malmquist to estimate and evaluate the efficiency of government health expenditure in 30 provinces(except Tibet)from 2009 to 2019 from static and dynamic perspectives.Selected fiscal decentralization as the core explanatory variables and local government competition as the moderating variable to study the mechanism of their effects on the efficiency of government health expenditure.Through the above empirical analysis,it can be concluded that the local government’s medical and health expenditure efficiency does not achieve DEA effectively,the regional differences show a trend of reduction,the expenditure scale does not reach the optimal level and the government management level is low,which are the main internal factors that limit the improvement of comprehensive efficiency.The decline of technological progress index limits the improvement of total factor productivity of government health expenditure;Fiscal decentralization and local government competition have a significant negative effect on the expenditure efficiency of government health care,and local government competition has a negative regulating effect on the expenditure efficiency of fiscal decentralization,which will further intensify the negative effect of fiscal decentralization on efficiency.Finally,based on the above conclusions,This paper proposes the following suggestions: optimizing the scale and structure of government medical and health expenditure according to local conditions;accelerating the construction of the public health system;improving the government medical and health expenditure management mechanism;rationally dividing the financial and administrative powers between the central and local governments;establishing a scientific and reasonable official performance evaluation system.