县级政府医疗卫生支出外部性:实证估计与策略识别

Externality of Medical Expenditure of County-level Governments:Empirical Assessment and Strategy Identification

财政分权体制下地方政府间公共品供给的竞争成为地区竞争的重要内容。本文选取与公众福利密切相关但现有文献又鲜少涉及的医疗卫生服务为例,采用空间计量模型,实证估计县级政府医疗卫生支出外部性的存在性与类型。本文研究发现,隶属于同一地级市及经济发展水平相近的县之间,策略互补是县级政府医疗卫生竞争的主要策略;从跨期看,地理距离相近的县级政府之间存在医疗卫生支出的策略替代。本文进一步识别了医疗卫生服务外部性是来源于以争夺流动性资源为目的的财政竞争还是"自上而下"的标尺竞争,研究发现,较之财政竞争,"自上而下"的标尺竞争在县级政府医疗卫生服务中影响更大。

Under the system of fiscal decentralization, the competition between the supply of public goods among local governments has become an important part of regional competition. This paper chooses as the topic the medical service which is closely related to the public welfare but is rarely mentioned in existing literatures, and uses the spatial econometric model to estimate the existence and types of the externalities of county-level governments＇ medical expenditure. The results of the study are as follows ： The complementatT strategy is the main strategy for the medical and health competition among county-level gov- ernments, which belong to the same prefecture-level city and whose economic development is at similar level; across the hori- zon, there is a policy alternative to health care spending among county-level governments with similar geographical distances. This paper further examines whether the external liquidity- of medical and health services originates from the fiscal competition for resources or from the ＂top-down＂ yardstick competition. The study finds that compared with the fiscal competition, the ＂top-down＂ yardstick competition has a greater impact on the medical and health competition services among county-level gov- ernnlents.