财政分权、转移支付与地区公共卫生服务均等化实证研究

Fiscal Decentralization,Central Transfer and the Equalization of China's Public Health Service

主流的财政分权理论一般认为,通过"用手投票"和"用脚投票"两种机制可以提高教育、卫生、社会保障等方面的社会福利水平。使用1997-2006年中国大陆省级面板数据检验财政分权和转移支付对中国公共卫生服务均等化的影响,发现财政分权和转移支付对公共卫生服务供给和均等化的影响取决于采用何种财政分权指标以及采用何种公共卫生服务测度指标,总体上而言,财政分权加剧了地区间人均预算卫生经费支出和每万人拥有医院卫生院床位数差距,但对每万人拥有卫生机构人员数差距的影响则依赖于采用何种分权指标;财政转移支付则有利于缩小地区间可及性公共卫生服务产出差距,但并没有缩小地区间人均卫生经费支出投入差距。

According to mainstream fiscal decentralization theory,social welfare in education,health care and social security will be enhanced by ＂voting with one＇s hands＂ and ＂voting with one＇s feet.＂ This paper investigates the effects of fiscal decentralization and central transfer on the equalization of China＇s public health service using provincial panel data since 1997. We find the conclusion depends on which fiscal decentralization index and public health service index are used. By and large,fiscal decentralization enlarges the regional disparity in per capita budgetary expenditure on public health and the number of hospital beds per 10000 population,but the effects of fiscal decentralization on the number of employed persons in health institutions per 10000 population depends on which fiscal decentralization index we use. Central transfer helps to reduce the disparity in public hearth products,but does not reduce the difference in per capita budgetary expenditure on public health.