财政分权、公共部门效率与医疗卫生服务供给

Fiscal Decentralization,Public Sector Efficiency and the Supply of Medical and Health Services

文章基于财政分权与公共部门效率间关系在我国仍未引起足够重视以及国外相关研究尚不成熟的现实背景,首先从理论层面构建财政分权与公共部门效率之间倒"U"形关系的理论框架;然后在构建财政分权组合指标体系的基础上,运用三种组合指标预测方法和Shannon-Spearman方法对中国式财政分权水平重新进行测度;并将公共部门提供公共服务的全要素生产率指数分解为技术效率指数与技术进步指数,以医疗卫生部门为例,采取Malmquist生产率指数方法全面测度我国地方政府医疗卫生服务供给的三种效率指数;最后选择以财政分权作为门限变量建立面板门限回归模型,实证检验财政分权与医疗卫生服务供给之间是否存在倒"U"形关系。研究发现:(1)当财政分权位于第一和第二区域内,即分权水平小于0.5263时,财政分权水平的增加有利于医疗卫生服务供给效率的提升;但当财政分权从第一区制进入第二区域内,即分权水平位于0.3643与0.5263之间时,财政分权对医疗卫生服务供给效率的激励效应出现下降。(2)当财政分权进入第三区域内,即分权水平大于0.5263时,财政分权与医疗卫生服务供给效率之间负相关,即财政分权水平的提高反而不利于医疗卫生服务的供给。(3)财政分权与医疗卫生服务供给之间的倒"U"形关系主要是通过影响医疗卫生服务供给的技术进步实现的。

Based on the real background that the relationship between fiscal decentralization and public sector efficiency still does not attract enough attention in China and related foreign research is not mature yet,this paper established a theoretical analytical framework about the inverted U-shape relationship between fiscal decentralization and public sector efficiency at the theoretical level.Then it uses three combined indicator prediction methods and the method of Shannon-Spearman to re-measure the level of fiscal decentralization of China on the basis of building combined index system of fiscal decentralization.And it divides the total factor productivity index of public services provided by public sector into technology efficiency index and technology progress index,and employs the Malmquist productivity index to measure three efficiency indexes of medical and health services supplied by local governments,taking health sector as an example.Finally this paper takes fiscal decentralization as a threshold variable to establish a panel threshold regression model which is used to examine the inverted U-shape relationship between fiscal decentralization and the supply of medical and health services.It reaches the following results:firstly,when fiscal decentralization is located in the first and second districts,namely the decentralization level is lower than 0.5263,the increase in fiscal decentralization is conducive to the improvement of the supply efficiency of medical and health services;but while the decentralization level is between 0.3643 and 0.5263,the incentive effect of fiscal decentralization on the supply efficiency of medical and health services decreases;secondly,when fiscal decentralization enters the third district,namely the decentralization level is higher than 0.5263,there is a negative relationship between fiscal decentralization and the supply efficiency of medical and health services,namely the increase in fiscal decentralization is not beneficial to the supply of medical and health services instead;thirdly,the inverted U-shape relationship between fiscal decentralization and the supply of medical and health services mainly depends on the effect on technology progress of the supply of medical and health services.