Research On Efficiency Of Fiscal Health Expenditure In Central China

With the continuous development of economy and the advancement of medical reform in China,the national income level and health quality have significantly improved,and higher requirements have been placed on public health standards.At the same time,the acceleration of the industrialization,urbanization,and population aging has also greatly increased social demand for health care.In recent years,the governments have continued to expand the scale of investment in health care to meet the demand.However,the slowdown in economic growth and the implementation of tax reduction policies such as " replacing business tax with value-added tax " have made China's fiscal revenue shrink year by year.Therefore,the contradiction between the growing demand for health care and limited financial funds have put forward requirements for the efficiency of health expenditures.Based on this,the fiscal health expenditures of the six provinces in central China after the medical reform in 2009 are selected as the research object to evaluates the efficiency,and then discusses how to improve the efficiency of fiscal health expenditures based on the analysis of influencing factors.Firstly,this paper analyzes the necessity and effectiveness of the government's participation in health care with the analysis of existing literatures.Then it analyzes the current state of fiscal health expenditures in central China from the aspect of expenditure scale and structure.After that,the relevant theories and research methods of the efficiency of fiscal expenditures are combed,laying the foundation for subsequent research.In terms of empirical analysis,it is divided into two parts.The first part is to evaluate the efficiency of fiscal health expenditure in the central China.The input-output process of health expenditure is divided into the output stage of medical resources and the output stage of health results.The two-stage DEA model and Malmquist productivity index are used to analyze the efficiency of fiscal health expenditures in the six central provinces statically and dynamically.In the selection of indicators,factors such as medical resources,health services,and national health levels are taken into consideration,and then an indicator system is built with fiscal health expenditures as input,medical resource as intermediate output,health service and the health results as the final output.The results show that the overall efficiency of fiscal health expenditures in the central region is relatively high,and the level of pure technical efficiency is significantly higher than that of scale efficiency.At the same time,there was a small dynamic increase in total factor productivity,with an average annual increase of 0.7%.From a staged analysis,the efficiency of the health results output stage is higher.In addition,there are differences in efficiency levels among the six provinces,with Jiangxi Province having the highest technical efficiency and Anhui Province having the lowest.The four provinces of Shanxi,Hubei,Jiangxi,and Henan showed strong efficiency growth momentum,while the total factor productivity of Anhui and Hunan provinces declined.The second part is to use the Tobit model to analyze the influencing factors by using the measured comprehensive technical efficiency as the explained variable.The results show that GDP per capita and transfer payments per capita have a significant positive impact on the efficiency of fiscal health expenditure,while the level of urbanization,population density and fiscal decentralization have a negative impact.Finally,in terms of conclusions and policy recommendations,based on the conclusion of Tobit regression analysis and the problems found in the evaluation of the efficiency and the status quo analysis of fiscal health expenditure in central China,the policy recommendations are proposed from the three aspects of fiscal expenditure scale and structure,budget supervision and management,and fiscal system.