摘要
分权体制框架下地级市政府在制定医疗卫生支出决策时往往会受到相邻城市相关策略的影响,从而引发城市间政府卫生支出的策略互动行为。文章选取了2007-2013年中国283个城市面板数据,运用动态空间面板模型检验了分权体制下地市级政府卫生支出的策略互动行为,并揭示出财政分权及其城市间空间策略互动对政府卫生支出的影响。研究发现,地市级政府在政府卫生支出上存在显著的互补型策略互动,这种效应在地理距离相近的同省区城市间更为显著。进一步分析发现,财政分权促进了政府卫生服务供给;而无论是短期还是长期,地市级政府间财政分权的策略互动对政府卫生支出产生明显的抑制作用,从而较好地解释了政府卫生支出比重徘徊不前的原因。由此,积极利用竞争、激励机制以及实现财政体制安排的优化变革来引导政府的卫生服务供给将是重要的政策选择。
Medical and health services concerns the well-being of people. It is fundamental for promoting the construction of China’s people-centered health strategy and realizing the development for the benefit of all. This study proposes a theoretical model of yardstick competition "from the top" and discusses the existence of inter-city tactful interaction behaviors in healthcare spending among prefectural-level municipal governments within the framework of a decentralized system. Very often, healthcare spending decisions made by prefectural-level municipal governments are influenced by the relevant strategies of the neighboring cities.Based on the data from 283 prefectural-level cities in China from 2007–2013, and using the dynamic spatial Durbin model(SDM), empirical tests are performed at the prefectural level to investigate the effects of interactions between cities within the same province, as well as the impacts of fiscal decentralization and its spatial tactful interactions in healthcare spending. We conclude that significant strategic interactions exist among municipal governments in government healthcare spending. Furthermore, the strategic interaction of government healthcare spending belongs to complementarities. This indicates that if the adjacent municipal government raises the level of healthcare spending in the same province, the city government’s optimal strategy will be to increase the level of government health spending accordingly, with cities characterized by geographical proximity and competing more strongly for government healthcare spending. Moreover, fiscal decentralization seems to drive the supply of government health services, as tactful interactions tend to limit government health spending. This explains why the share of government health spending has been hovering at around 2%. Overall, the implementation of competitive or incentive mechanisms and optimized financial arrangements emerge as a truly effective policy to stimulate the supply of government health services. The potential contributions of this paper are as follows. Firstly, in theoretical research, considering welfare maximization decision-making under the restriction of limited resources, this paper develops a "topdown" competition model for government healthcare spending between municipal governments using the interaction theory framework. Secondly, the dynamic spatial Durbin model(SDM) is used to solve the "path dependence" characteristics of government healthcare spending and to ease the problem of "endogeneity". The research conclusion is more accurate after a comprehensive consideration of government healthcare spending over time, space, and time-space lag effects. Thirdly, based on a panel data of 283 prefectural-level cities from2007–2013, this paper projects a micro and accurate description of the competing behaviors of prefecturallevel city governments. Finally, from a research perspective, this paper contributes practical value by examining the strategic interactions in government healthcare spending behaviors, and shows the short-and long-term effects of fiscal decentralization and the strategic competition for space in government healthcare spending.
作者
彭冲
汤二子
Peng Chong;Tang Erzi(School of Economics, Nanjing Audit University, Nanjing 211815, China)
出处
《财经研究》
CSSCI
北大核心
2018年第6期94-108,共15页
Journal of Finance and Economics
基金
教育部人文社会科学基金青年项目(16YJC790079)
中国博士后基金面上项目(2017M620200)
江苏省博士后基金项目(1701084C)
关键词
财政分权
地方政府
卫生支出
动态空间Durbin模型
financial decentralization
local governments
healthcare spending
dynamic spatial Durbin model