财政支出、政府竞争与医疗卫生服务水平——基于省级面板熵值tobit模型的实证分析

Fiscal Expenditure,Government Competition and Medical and Healthcare Service Level:An Empirical Analysis Based on Provincial Panel Entropy Tobit Model

医疗卫生服务水平关系到人民群众的身体健康,是健康中国建设的重要保障。为精准把握中国省级医疗卫生服务水平及其影响因素,从医疗卫生服务投入和产出两大维度构建指标体系,在对省级医疗卫生服务水平综合指数熵值处理的基础上,构建面板tobit模型,实证检验财政支出、政府竞争对医疗卫生服务水平的影响。结果显示:(1)样本考察期内,中国省级医疗卫生服务水平呈现“先快后慢”的提升趋势,区域异质性特征明显;医疗卫生服务投入逐年稳步增长,但医疗卫生服务产出水平提升不明显。(2)财政支出和政府竞争能促进医疗卫生服务水平的提升,但过度的政府竞争具有抑制作用,且具有明显的地区差异;财政支出对中部地区医疗卫生服务水平的促进效应最明显,西部地区次之,东部地区最弱;加入财政支出和政府竞争的交互项的实证结果显示,财政支出在促进医疗卫生服务水平提升过程中,对政府竞争的依赖较小,而政府竞争的抑制作用则较大程度地依赖于财政支出规模。而且财政支出、政府竞争对医疗卫生服务水平的影响均存在单一门槛效应。(3)在系列控制变量中,医疗保障和人均GDP显著促进医疗卫生服务水平的提升,而财政收入、医疗消费指数和人口密度的作用相反,上述控制变量对医疗卫生服务水平的影响存在地区差异。以上结论对新时期提升中国省级医疗卫生服务水平具有重要的政策启示。

The level of medical and healthcare services is related to people’s health,which is an important guarantee for the construction of a healthy China.To accurately grasp the level of provincial medical and healthcare services in China and its influencing factors,the input and output of medical and healthcare services are taken as two important dimensions to build index system.Based on processing the entropy value of the comprehensive index of provincial medical and healthcare service level,the panel Tobit model is constructed to empirically test the influence of fiscal expenditure and government competition on medical and healthcare service level.The results show that(1)during the sample study period,the level of provincial medical and healthcare services showed an upward trend from“fast development to slow development”,with obvious regional heterogeneity;The input of medical and healthcare services has been growing steadily year by year,but the output level has not been improved significantly.(2)Fiscal expenditure and government competition can promote the improvement of medical and healthcare service level,but excessive government competition has a restraining effect and has obvious regional differences;the promotion effect in central region is the most obvious,followed by western region,and the weakest in eastern region.The empirical results of the interaction between fiscal expenditure and government competition show that fiscal expenditure is less dependent on government competition in promoting the improvement of medical and healthcare service level,while the inhibiting effect of government competition largely depends on the scale of fiscal expenditure.Moreover,both fiscal expenditure and government competition have single threshold effect on medical and healthcare service level.(3)Among the series of control variables,medical guarantee and per capita GDP significantly promote the improvement of medical and healthcare service level,while fiscal revenue,medical consumption index and population density have opposite effects.The influence of the above control variables on medical and healthcare service level has regional differences.The above conclusions have important policy implications to enhance the level of China’s provincial medical and healthcare services in the new period.