中国财政分权制度对政府卫生支出效率的影响研究

The Impact of Fiscal Decentralization on the Efficiency of Government Health Expenditure

我国财政分权制度对政府卫生支出效率具有重要影响。中央和地方政府在财政收支格局中的不平衡降低了地方政府卫生支出的积极性,并间接导致了医疗机构的过度医疗和以药养医,造成政府卫生支出的浪费;地方政府承担卫生支出的主要责任导致中西部地区的政府卫生支出水平和占比明显低于东部地区,但卫生支出效率高于东部,卫生支出向资源已相对饱和的东部地区不断集中造成了整体支出效率低下;卫生事业的各级政府层层负责制导致卫生资源向上集中,从而造成医疗支出的低效。尤其是"重城轻乡"的格局不利于卫生支出流向健康水平更低的农村地区。要扭转这些负面影响机制,提高政府卫生支出效率,需要从多层面的经济和医疗卫生制度着手进行相关改革。

The system of fiscal decentralization has important impact on the efficiency of government health expenditure in China. Firstly, the unbalanced roles of the central and local governmental in the fiscal revenue and expenditure reduce the local governments＇ enthusiasm in the health expenditure, and indirectly lead to the excessive medical treatment, and then create the waste of governmental health expenditure; Secondly, the local government bears the main responsibility leading to the level and ratio of health expenditure of middle-western regions is obviously lower than the eastern regions, but the efficiency is higher than them, then the efficiency of health expenditure is decreased as the health expenditure continuously focusing on the eastern regions where the health resources have been relatively saturated; Thirdly, the widening of the disparity of regional government health expenditure, and increasing of the unbalance of health expenditure levels between urban-rural areas and among different administrative levels. Fourthly, the regulation of different administrative levels＇ government is responsible for its own level＇s health expenditure makes the health resources focus on the higher level, then lead to the low efficiency of the health expenditure.Especially, the pattern of ＂urban-bias＂ is not good for the health expenditure flowing to the rural regions which have poorer health situation.