Study On The Economic Effect Of Public Health Expenditure On Household Behavior Of Farmers

The "healthy China" plan is an important national strategy in China,which highlights the significance of building a national public health system.Public health systems at all levels,from the central to the local,are playing an irreplaceable role in the implementation of this program.The practice of building this public health system has exposed its problems,which proves the system needs to be improved.Compared with urban areas,the public health system in rural areas has a late start and a low level,so there is still much room for improvement.Even so,public health expenditure still plays an irreplaceable role in the current economic growth in rural areas,especially the impact on farmers' production behavior is both "tangible" and "intangible".Nowadays,there are two main kinds of production behaviors of rural residents: one is to engage in agricultural production,and the other is to transfer labor to cities to engage in non-agricultural production.Exploring the impact of government public health expenditures on farmers 'production behavior is an important way to evaluate the economic effects of public health expenditure policies.Based on this,this paper,from the perspective of government public health expenditure,takes farmers as the main research object,and analyzes the characteristics and changes of household agricultural production and labor transfer behavior under the dual role of government public health expenditure and family medical expenditure,so as to provide a decision-making reference for the improvement of public health expenditure policy in rural areas.In recent years,the scale of public health expenditure in China has increased rapidly,playing an important role in safeguarding the health of residents.Compared with urban residents,the increase in public health expenditure has a greater marginal impact on rural households.First,because of the poor public health conditions and foundation in rural areas,each increase of a certain proportion of public health expenditure produces higher utility;second,farmers engaged in agricultural production are at higher risk of diseases due to poor basic sanitation.Public health investment can ease the burden of farmers' medical expenditure,and has a significant effect on improving their own utility.This paper defines the impact of public health expenditure behavior on farmers 'production behavior,and divides the impact into two types: first,the increase of public health expenditure directly raises the level of basic health care in rural areas,and improves the basic health level of rural residents,causing farmers to increase agricultural production inputs and obtain a higher level of agricultural output;second,the increase in the health level of rural residents brought about by the increase in public health expenditures indirectly increases the probability of rural residents(surplus labor)transferring to the secondary and tertiary industries in urban areas,and provides impetus for urban economic and social development.The two economic influences jointly reflect the importance of public health expenditure,and the link variable of the two economic influences is "health".Therefore,the empirical part of this paper firstly analyzes the impact of public health expenditure on the health output of peasant households,and then analyzes the changes of peasant households' production behaviors after the improvement of health level.In this paper,panel Logit model,panel Probit model,fixed effect panel Logit model and bidirectional fixed effect model are used for quantitative research.In view of the differences in analysis objects and variables,there are two sources for the data studied in this paper: one is China health and old-age care tracking survey data(CHARLS);the other China health and nutrition survey data(CHNS).The logic of this paper is "one main line" and "one secondary line".The main line is whether the economic behavior of rural households changes with the increase of public health expenditure in China,or whether residents in rural areas have benefited(whether their income or ability to obtain income has been improved).In this paper,farmers' production behavior is used to measure whether farmers benefit.In rural areas,farmers' income mainly comes from two aspects,namely,agricultural output and nonagricultural output.The former is the income of agricultural production,while the latter is mainly reflected in the wage income after the transfer to the second and third industries.Why can the increase of public health expenditure affect farmers' income levels? There are two main processes: first,the increase of public health expenditure has improved farmers' health,and this improvement has enabled farmers to devote more energy to agricultural production;second,the increase in public health expenditure has improved the health of farmers,which will greatly increase the probability of their transfer to the secondary and tertiary industries,and the income obtained from non-agricultural industries is much higher than the income obtained from traditional agricultural production.The secondary line is whether the health level of rural residents has been improved in a real sense with the increase of public health expenditure in China? According to the main line,we can know that the middle link of the impact of the increase of public health expenditure on the input and output of farmers' agricultural production and labor transfer behavior should be "the increase of public health expenditure greatly improves the health capital level of farmers".Many scholars have confirmed this point of view.This paper will test it again through theoretical demonstration and empirical data,and further demonstrate the establishment of the main line effect.Based on the above logic,the main structure of this paper is as follows:The first part is the question and background analysis,which is the introduction part.This part mainly explains the background,significance,purpose,content,idea,method,innovation and deficiency of this paper.The second part is the theoretical basis of this paper,which is Chapter 1.This part is the cornerstone of this paper.First,this part defines the relevant concepts of this paper and lays the conceptual foundation of this paper.Secondly,this part explains the basic theories related to the research,such as healthy human capital theory,urban-rural dual economic theory and neoclassical economic growth theory,which lays a theoretical foundation for this paper.Finally,this part sorts out and summarizes relevant literatures,and clarifies the current research on public health expenditure,agricultural labor transfer,and agricultural production and their relations,which lay the foundation for the research of this paper.The third part is the analysis of the current situation,which is Chapter 2.This chapter will focus on the development trend and regional differences of China's public health expenditure policies,and on the basis of regional differences,the logical relationship between public health expenditure and farmers' production behavior is elaborated,which will lay a logical foundation for the subsequent empirical analysis.The fourth part is the sub line research,which is Chapter 3.This paper mainly tests the health output effect of public health expenditure,analyzes whether the health output variables of farmers change or improve after the increase of public health expenditure,and analyzes the degree and reason of improvement.The fifth part is the main line research,including Chapters 4 and 5.The first is to study the impact of public health expenditure on the production input and output of rural households in Chapter 4.As one of the core contents of this paper,this chapter will analyze the impact of government public health expenditure combined with household medical expenditure on household agricultural production input and output through theoretical and empirical analysis.The second is to study the impact of public health expenditure on household labor transfer in chapter five.As the second core content of this paper,this chapter will focus on analyzing whether the probability or proportion of rural household members to engage in off-farm production will increase with the increase of local government's public health expenditure.The sixth part is the conclusion and policy suggestion of this paper,which is Chapter 6.The main content of this part is to summarize the research conclusion of this paper and discuss the policy suggestions to improve the efficiency and effect of public health expenditure.Based on the above content arrangement,this paper has three main conclusions:First,in rural areas,the health output effect of public health expenditure is more obvious,which is manifested as an impact on the three health behaviors of rural residents.First,the health effect of the basic environment and services of rural public health is more significant,among which the health effects of "accessibility of nearby hospitals,distance" and "frequency of physical examination" are more obvious;the health effects of "source of domestic drinking water" and "type of domestic toilet water" are also obvious,but they are weaker than the previous two variables.It is worth mentioning that the impact of "medical insurance participation" is more prominent.The results show that after farmers participate in medical insurance,the probability of health level improvement increases by 9.78%.Active participation in medical insurance is an important part of the national health policy.For farmers,participation in medical insurance can greatly reduce the burden of their medical expenditure,but also to some extent improve their enthusiasm to see a doctor.The improvement of their health level is relatively obvious.Second,the health effects of individual characteristics of farmers need to be treated with caution.Among them,the agespecific health output effects of farmers are the most obvious,and the regression coefficient is-0.0238(significant at 1% confidence level),which shows that with the growth of farmers' age,the health level declines rapidly.Although it is a negative impact,the significance level shows that the health output effect of farmers is more obvious;The difference between urban and rural areas measured by household registration variables is also significant;the correlation between urban household registration and income variables is relatively large,resulting in the same health effect;the health effect of education years,marital status and gender is not obvious;active participation in exercise is conducive to the improvement of health level,and appropriate drinking will improve health,but there is no clear evidence of a negative correlation of smoking with health.Third,there is a significant difference between the income difference and the health effect of medical insurance participation.The higher the income of urban residents have,the more they tend to choose large hospitals with high treatment levels rather than nearby treatment(-0.0942 **),while residents with lower incomes are more likely to choose medical services nearby(-0.0837 ***);because of the lower income of rural residents,the expenditure budget of medical insurance is not high,and the social medical insurance is not high The improvement of insurance is more important for them(0.0878 ***),while for urban residents with higher income level,in addition to the optional social medical insurance,commercial medical insurance is also an important choice(0.0745 *);the younger the residents,the stronger the medical examination awareness,the greater the probability of self-improvement,and the more enthusiastic to participate in social medical insurance.Secondly,the public health expenditure has a heterogeneous impact on the input and output of agricultural production.First,the increase of public health expenditure has increased the health human capital of rural residents.Farmers who originally dominated agricultural production will increase agricultural input and agricultural output will increase accordingly;farmers that do not primarily rely on agricultural production will increase the probability of going out to engage in non-agricultural production,while the agricultural production output will decrease and the non-agricultural production output will increase.Second,the probability of non-agricultural production of the farmers who did not focus on agricultural production increased,that is to say,most of the farmers transferred to the second and third industries of cities for higher income.Third,in the sample area,because the nonagricultural farmers are specialized in the second and third industries of cities and towns,the original agricultural land will be rented at a certain price,the household land rental income will increase,and the agricultural production output will decrease,that is,in this case,public health expenditure will not only lead to the reduction of non-agricultural regional agricultural production input,but also lead to the reduction of agricultural production output.Fourth,the increase of public health expenditure indirectly produces the effect of promoting land scale management,that is,when non-agricultural farmers reduce the input of agricultural production and transfer to the second and third industries of cities and towns,a large number of agricultural land is vacated and transferred,large-scale agricultural production is possible,and the efficiency is improved.However,this land value-added has different effects on different industries.The efficiency of traditional plantation and forestry is not obvious,but there is a downward trend.The impact on farmers of animal husbandry and aquaculture is relatively insignificant because it is an industry with high added value and does not easily cause labor transfer.Thirdly,the public health expenditure has significantly promoted the transfer of rural surplus labor to the second and tertiary industries by improving the health level of farmers,but at the same time,it has shown the heterogeneity effect.First,public health expenditure has generally improved the health level of rural residents,raised the health capital of rural residents,and accelerated the rate of labor transfer.However,due to the differences of individual health storage level,family medical expenditure,regional medical access and other factors,there are differences in the promotion degree of health capital,so there are also differences in the labor migration behavior of rural residents after the promotion of health capital.The health level of the farmers with high level of original health reserve is not significantly improved due to the increase of public health expenditure,and the probability of labor migration is not high(originally in the state of going out to work);the health level of the farmers with low level of original health reserve is significantly improved due to the increase of public health expenditure,and they move to the second and third industries of cities The probability of displacement is high.Second,due to the high risk of rural households moving from rural areas to urban secondary and tertiary industries,it will cause significant health losses.Therefore,the continuity and competitiveness of non-agricultural production will be weak,which will result in the return of agricultural labor.Public health expenditures compensate for the health losses of transferred labor and reduce their return.