Abstract
Based on the construction of different caliber fiscal decentralization and local public health expenditure index, this paper makes an empirical analysis of the influencing factors of local public health expenditure in China by using the methods of FGLS and dynamic panel GMM. It is found that different fiscal decentralization indicators have different effects on public health expenditure, and local governments have a large right of financial autonomy to effectively increase public health expenditure, and the central government's transfer payment to local governments also has a significant positive effect on local public health expenditure. In addition, the difference in the level of local economic development will result in uneven local public health expenditure, manifested in the double imbalance between the expenditure structure and the provision of public health services. Therefore, China should continue to increase the central transfer payment, reasonably divide the central and local financial authority, establish a hard restraint mechanism of local public health expenditure, clarify the expenditure responsibility boundary between the central and local governments, and implement the measures of combining central supervision and control with local financial autonomy, in order to solve the problem of the double imbalance between regional and regional expenditure of local public health expenditure and ensure the effective supply of local public health products.
Highlights
As a public product, the government has an unshirkable responsibility for its development
China is paying more and more attention to public health development and increasing fiscal investment, especially when the country's public health vulnerabilities exposed in the 2003 "SARS" events, the state has staged a series of legal policy to encourage the development of public health, such as “the state council on health reform and development of decision regulation” which was promulgated by the central committee of the CCP in 1997, it stipulated that the government's investment in health should increase year by year with the development of the economy, and the increase should not be lower than the growth of fiscal expenditure in that year
Liu Zhenghua analyzed the panel data at the provincial level in China, and the results showed that there was a negative correlation between fiscal decentralization and public health expenditure, while fiscal self-sufficiency and per capita transfer payments had a positive impact on the proportion of public health expenditure [15]
Summary
The government has an unshirkable responsibility for its development. Compared with the rapid growth of GDP, the development of public health services in China lags behind, and many problems remain prominent: government health accounts for the proportion of the total health expenses is very low (figure 1), large medical expenses shall be borne by the society and individual, still in China's GDP has climbed the world's second today, the country's medical and health care spending as a share of GDP ranked 145th Problems such as the shortage of total health resources, unreasonable structure, uneven distribution, relatively single supply subject, and weak service capacity at the grassroots level remain prominent. The sharing of fiscal expenditures between governments at all levels depends on the division of financial and power rights of governments at all levels, and the adoption of national laws stipulates the public affairs that governments at all levels should be responsible for This provides a new perspective for the research in this study. From the perspective of fiscal decentralization, this study will empirically analyze the current situation of public health expenditures of local governments in China, and analyze the impact of fiscal decentralization and other relevant factors on public health expenditures of local government through panel data
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