Equalization Of Basic Medical Health Services And Transfer Payment Arrangements In China

The equalization of basic medical and health services has always been the issue of people’s livelihood that the government and citizens are both eagerly concerned.The 18th Party Congress has repeatedly stressed that the overall realization of basic public services is an important part of the strategic goal of building a well-off society in 2020.Exploring this issue from the perspective of fiscal transfer payment arrangement,is in line with the current social needs:On one hand,it not only can promote the development of basic medical and health services in our country,thus to solve the problems of medical treatment and improve the people’s well-being,but also can promote the realization of social fairness and justice,on the other hand,it is helpful in providing some humble opinion for exploration of fiscal transfer payment mode.In order to ensure the rigor and scientificity of the research process and the results,this paper uses a variety of research methods,including the combination of quantitative research and qualitative research,empirical research and normative research,static analysis and dynamic analysis,as well as comparative analysis method.Specific to the empirical analysis,it mainly including the four modules:the use of TOPSIS-principal component analysis of the provincial basic medical and health services to measure the level and sort according their scores;the use of Theil index measuring non-equalization degree of basic medical and health services within 31 provinces;the use of the cointegration test to verify the feasibility of the path of financial-horizontal equalization;the use of feasible generalized least squares(FGLS)to estimate the provincial basic medical and health service demand.This article contains seven chapters,with a total of about 50,000 words,the contents and structure of the text are as follows:The first chapter is the introduction.Firstly,the background and significance of the topic are explained,and then the relevant domestic and foreign research literatures are reviewed and introduced.On the basis of summarizing the existing research,to form the logical system and basic structure.Finally,the main contents of this paper are expounded,the main research methods are clarified,and the innovation and limitation in the research are also clarified.The second chapter,as the logical starting point of this article,will sort out the basic theory and analysis methods of basic medical service with its equalization and financial transfer payment as a basic theoretical framework for the research of this paper.First of all,to describe the basic theory of basic medical and health services,including the definition of basic medical and health services and their equalization,and the theory of the realization of basic medical and health services equalization:the use of welfare economics theory and public finance theory as the representative theory to analyze the realization of the equalization of basic medical and health.Secondly,the basic theory and analysis framework of financial transfer payment are discussed,including the concept and type of financial transfer payment,and the operation mechanism of financial transfer payment to realize equalization of financial resources.This chapter mainly provides a theoretical analysis framework and basis for the later analysis in this paper.The third chapter is the ranking and measurement of the basic medical and health level of 31 provincial administrative regions in China.The method is TOPSIS-principal component analysis.First of all,the basic evaluation system of basic medical and health service level is constructed,and the specific indicators of each dimension are selected to describe the basic medical and health service in the two-dimension framework of "input-output".Before the empirical analysis,the TOPSIS-principal component analysis method is briefly introduced,because the method is an improvement of the traditional principal component analysis method,which can be used to analyze the panel data.Then the empirical analysis is mainly based on the "input-output" framework from the dimensions of total and per capita quantity calculation.The research process of the two dimensions is the same,that is,after the principal component of each year are extracted,the comprehensive score is calculated and transformed into the final score by using TOPSIS method to figure out the proximity with the best state.According to the results of the ranking in per capita dimension,the regional division is carried out according to the score level,and the hierarchical color map is plotted to provide the statistical basis for the proposal of the transitional regional co-ordination mechanism.The fourth chapter is the measure of the non-equalization of the provincial basic medical and health resources.In order to show the overall disparity of the basic level of medical and health services,the interregional gap between the eastern,central and western regions and the northeastern region,the internal disparity of the region and their contribution to the total gap,the Theil Index method is chosen.By using the selection of material,human and financial basic medical Health resources as a measure of the calculation,the results show that the non-equal degree of financial resources is the most serious,thus it can be deduced that the equalization of basic medical and health services can be achieved by means of equalization of financial resources.The fifth chapter is the analysis of the effect of equalization of financial resources on horizontal equalization.The first is the theoretical analysis,including the economic effects analysis of the different types of transfer payments under the framework of Western economic theory.Then there is the empirical analysis,mainly through a simple cointegration test to verify the feasibility of financial equalization to achieve basic public service equalization.However,the empirical study of many domestic scholars shows that the effect of China’s transfer payment system is not ideal,which means that China’s current transfer payment system needs to be further optimized and innovated,although the co-integration results are positive.The sixth chapter is the optimal design of balanced transfer payment scheme in the basic medical and health service field.The reason why the balanced transfer payment system is taken as an example is that it is the most important form of transfer payment in the general transfer payment system and the only institutional arrangement for the allocation of funds in accordance with the standardized formula.Firstly,the formula of determining the amount of funds is described and evaluated.The optimization solution of balanced transfer payment scheme is put forward by using the drawbacks of existing formula as the starting point.That is,establishing the basic medical and health service demand estimation model by using FGLS,and then puting the specific data into the needs calculation model of basic medical and health to calculate the basic medical and health real needs of a region under the conditions of equalization,and as a benchmark,compared to current regional government health spending to discuss the optimization scheme of transfer payment under the different duties and responsibilities system.The seventh chapter is the policy orientation to promote the equalization of provincial basic health care.From the perspective of optimizing the transfer payment system,we hope that through dividing government responsibility and expenditure responsibilities,optimizing the transfer payment structure and public service capital investment mechanism,innovating transfer payment incentive mechanism design,improving the protection of the financial level to reduce the horizontal transfer payment resistance and other ways to improve the current transfer payment system.The innovation of this paper lies in the selection of the medical and health resources index and the establishment of the comprehensive evaluation system,as well as the introduction of the transitional regional co-ordination mechanism of the basic medical and health care funds.The innovation of the empirical aspect lies in the analysis of the principal component of the panel data and optimized design for balanced transfer payment fund arrangement for specific areas.Of course,there are shortcomings,including the inaccuracy of the model estimates and the lack of detailed research of incentive mechanism for transfer payment.