Research On The Effect Of Fiscal Decentralization On Efficiency Of Local Fiscal Expenditure On Health Care

China’s fiscal decentralization system has undergone numerous reforms and the centraland-local fiscal relationship has experienced significant changes since the reform and opening to the outside world.Especially since the reform of the tax revenue distribution in1994,according to the principle of unity of fiscal power and business power,the connection of fiscal distribution is being gradually clarified;with the tax classification of each other’s fiscal revenue,the current fiscal decentralization system in China is basically formed.With the gradual development of the theory of China’s fiscal decentralization,a relatively stable system of decentralization has been basically formed,and the expenditure and supply of public goods in all aspects of economy and society has been increasingly affected under the fiscal decentralization system with the rapidly progressing economy.There is no doubt that the traditional theory of fiscal decentralization has laid a solid foundation for the domestic academic circles to study the fiscal decentralization’s effects on every aspect of social and economic.However,for our country,the decentralization system has not yet achieved the match between the power of expenditure and resource allocation.Under the "pressure-type" administrative system,local governments are more likely to be affected by performance appraisal incentives,so that they will invest more fiscal funds in economic construction and ignore the efficiency on the supply of public goods like health care,and the western theory of fiscal decentralization has probably drawn different conclusions compared to China’s.This paper selects the efficiency of local fiscal expenditure on health care as the starting point.Because in recent years,medical and health care has obviously increased in China’s concern.The outbreak of the “COVID 19” epidemic that swept the world in early 2020 has exposed some problems in the field of health care,causing the government and people to pay more urgent attention.This paper studies how to improve the efficiency of local fiscal expenditure on health care under the fiscal decentralization system.Based on the basic national conditions of our country and the summary of domestic and foreign research as well as related concepts and theories,this paper first defines the formula of Chinese-style fiscal decentralization,including the fiscal revenue decentralization,the fiscal expenditure decentralization and the fiscal autonomy decentralization.Then the application of panel Tobit and panel threshold model are used to analyze the impact of fiscal decentralization on the efficiency of fiscal expenditure on health care.This paper draws the results that the fiscal expenditure decentralization has a positive linear effect on the efficiency of fiscal expenditure on medical and health,while both the fiscal revenue decentralization and fiscal autonomy have a negative non-linear impact on it.Finally,according to the above empirical results,policy advocacy is put forward,such as giving more financial support to the medical and health field,taking more measures to optimize the efficiency of fund allocation,further delegating business power to local governments and collecting financial power to the central government,optimizing performance evaluation mechanisms of the local government,making sustainable development of local economy,and providing subsidies for the elderly and other vulnerable groups.To sum up,the main innovative point of this paper is reflected in the following aspects:one is to systematically analyze the mechanism of fiscal decentralization affecting the efficiency of medical and health expenditure,and break through the one sidedness of existing research content.The impact of fiscal decentralization on the efficiency of medical and health expenditure in China is tested by using three indicators of fiscal decentralization,i.e.fiscal revenue decentralization,fiscal expenditure decentralization and fiscal autonomy.This method overcomes the defects of single dimension index,and provides more abundant basic data for the follow-up study of the linear and nonlinear effects of fiscal decentralization on the efficiency of China’s government medical and health expenditure.The second respect is to analyze the impact of fiscal decentralization on the efficiency of local fiscal health expenditure by using linear and nonlinear regression methods,so as to avoid limiting the research to simple linear correlation from the perspective of linear effect,in which way the method innovation is realized.