The Influence Of Fiscal Decentralization On Local Medical And Health Expenditure

The continuous advancement of the national health care reform and the people’s concern about health reflect the national attention to the health situation.To improve the level of public health care is an important way to respond to the growing health needs of the people and to improve people’s physical quality and quality of life;it is an inevitable choice for China to cope with the challenge of aging and open the two child policy;it is also an important means to help the "healthy China" strategy and enhance the efficiency of service-oriented government transformation.As the main body of providing this public goods,the relationship between local governments and their behavior will have an important impact on the level of medical and health supply within the jurisdiction.On the basis of combing the existing literature research,combined with some problems existing in China’s local medical and health expenditure,this paper takes the financial relationship between the central government and local governments as the breakthrough point,in order to find some countermeasures to improve the level of local medical and health expenditure.This paper is based on the behavioral logic of fiscal decentralization affecting local medical and health expenditure: first,revenue decentralization.The improvement of revenue decentralization means the improvement of local government’s revenue autonomy and financial security,which is the capital basis for improving medical and health expenditure.But on the other hand,if there is no effective supervision mechanism,under the influence of the top-down government performance appraisal,the local government will inevitably pay more attention to economic construction expenditure and less attention to health care and people’s livelihood expenditure,which will make full income into the field of direct economic growth.The second is the decentralization of expenditure.Excessive decentralization of expenditure reflects the excessive decentralization of authority and expenditure responsibility.First,it will cause financial difficulties for local governments.If transfer payment can not effectively make up the gap between revenue and expenditure,local governments will first guarantee the basic operation and be unable to improve medical and health services.Secondly,if the principle of public goods benefit scope is violated,the higher government should transfer the responsibility to the lower government,which will inevitably lead to free riding behavior due to the externality of public goods,which is not conducive to actively increasing medical and health expenditure.Based on the panel data of 30 provinces(autonomous regions and municipalities)from 2009 to 2018,this paper uses the proportion of medical and health expenditure in the provincial financial expenditure to reflect the local medical and health expenditure.The core explanatory variables are set as fiscal expenditure decentralization and income decentralization.The GDP per capita,population aging rate and market-oriented rate are taken as control variables to establish a fixed effect model,The conclusions are as follows: first,decentralization of fiscal expenditure leads to a significant decline in the proportion of local medical and health expenditure.Second,the decentralization of fiscal revenue has brought about a decline in the proportion of local medical and health expenditure,but the impact is small.Therefore,this paper combines the above conclusions with the practical impact proposes to clarify the division of powers and expenditure responsibilities in the field of medical and health,improve the intergovernmental transfer payment system,reform the performance appraisal system of lower level government and innovate the medical and health supply Finally,some suggestions are put forward.