财政补贴对医院经营行为的影响研究

Effects of Public Subsidies on Hospital Management in China

本文以公立医院为例探讨公立机构的经济行为模式,聚焦财政补贴对公立医院行为模式和经营效率的影响机理。本文构建了一个涵盖财政补贴、医院投入和定价决策的理论模型,分析财政补贴对医院行为的影响机制。财政补贴的可得性,允许公立医院可以承受更高的经营亏损,使得医院可以通过扩张规模和提高技术水平,在吸引更多患者扩大市场规模的同时通过提高收费水平增加收益。模型预测财政补贴引致医院亏损运营,且补贴水平越高医院亏损规模越大。然后,使用十三个地市的医院微观数据,实证分析了财政补贴对医院支出行为的影响,并分析了财政补贴效应的异质性和因果机制。结果表明,增加财政补贴的确会提高医院亏损规模,进而降低其经营效率。

The Chinese government has made substantial investments in public hospitals,and government subsidies have become an essential source of income for these institutions.However,the specific impact of public financial input on hospital behavior and efficiency remains unclear.As China's economy experiences rapid growth and an aging population,healthcare demand urgently increases,making it imperative to improve the efficiency of public hospitals and promote better healthcare services.This study aims to explore the impact of public subsidies on the behavior and efficiency of public hospitals in China,which can inform policy decisions aimed at enhancing healthcare delivery in the country.The paper seeks to investigate the impact of public subsidies on hospital management in China,including how subsidies affect hospital spending behavior,operational efficiency,and market share.The study uses a combination of theoretical and empirical methods to answer this question and provide insights that can inform policy decisions aimed at improving healthcare delivery in China.In the theoretical analysis section,a model covering fiscal subsidies,hospital input,and pricing decisions is constructed to analyze the impact of fiscal subsidies on hospital behavior.The theoretical results indicate that the availability of fiscal subsidies allows public hospitals to tolerate higher operational losses,thereby attracting more patients by expanding their scale and improving their technical capabilities.Thus,hospitals can attract more patients and increase their market share while also raising their revenue by increasing fees.As a result,fiscal subsidies lead to hospital losses,and the higher the subsidy level,the larger the scale of hospital losses.In the empirical section,this paper uses data from public hospitals in 13 cities from 2008 to 2020,employing a panel data regression model and analyzing the impact of government subsidies on hospital behavior at both the hospital and regional levels.The empirical results show that increasing fiscal subsidies does indeed expand the scale of hospital losses,subsequently reducing their operational efficiency.At the same time,we also find that the impact of fiscal subsidies on hospitals of different sizes and types is heterogeneous.The empirical analysis confirms the theoretical model's prediction:increasing fiscal subsidies to hospitals leads to losses in their operations and reduced efficiency.Moreover,we find that the effects of fiscal subsidies vary among hospitals of different sizes and types.The main conclusion of this study is that fiscal subsidies have a negative impact on the operational behavior and efficiency of public hospitals.Specifically,increasing fiscal subsidies to hospitals results in an expansion of their loss scale and a decrease in their operational efficiency.Simultaneously,we find that the effects of fiscal subsidies vary among hospitals of different sizes and types.These findings have significant implications for the formulation of fiscal subsidy policies for public hospitals and for improving their operational efficiency.This study delves into the current state of healthcare investment in China and the operational models of public medical institutions,providing insights for policymakers to promote reforms related to healthcare investment policies.Increasing investment in the healthcare security system,including fiscal input,is one of the essential means to improve the allocation of resources in the healthcare market.Optimizing the fiscal input mechanism is crucial to achieving this goal.Simply basing expenditure on revenue can lead to various distortions;hospitals with more substantial fiscal subsidies experience looser budget constraints and excessively pursue the expansion of expenditure scale,resulting in reduced institutional efficiency and resource waste.Due to the mismatch between government responsibilities and available financial resources,fiscal resources are not distributed according to social needs but rather based on government levels and hospital tiers(sizes).This results in the continuous growth of tertiary hospitals,difficulties in developing small and medium-sized medical institutions,and the inability to form a hierarchical diagnosis and treatment structure.This not only weakens the accessibility of medical treatment for urban and rural residents but also increases medical expenses.Scarce fiscal funds are not effectively utilized.The academic community generally believes that fiscal subsidies for the demand side can more directly improve the welfare levels of families and individuals.Therefore,it is worth considering adjusting the current investment mechanism,allocating a more significant proportion of resources to the demand side while balancing both supply and demand.At the same time,it is also necessary to adjust the subsidy methods for the supply side to mitigate the efficiency loss and resource allocation distortion discussed in the text.