Centre for Contemporary Chinese Studies, The University of Melbourne, 761 Swanston Street, Parkville, VIC3010, Australia.
East Asian Institute, National University of Singapore, 469A Bukit Timah Road, Tower Block #06-01, Singapore, 259770, Singapore.
BMC Public Health. 2022 May 9;22(1):914. doi: 10.1186/s12889-022-13300-y.
The Chinese government launched health care reforms in 2009 and introduced a national list of essential public health services (EPHS) as an integral part of the plan to deliver health care for all. EPHS was also built into the national plan to promote the equalisation of public services across the country. A national standard was set for financial input to EPHS. As the services are co-funded by the central and local governments, a robust intergovernmental fiscal system is essential to guarantee that the hundreds of thousands of service providers have adequate financing to meet the service commitment.
We examined the flow of funds through China's complex intergovernmental fiscal system to see whether the promise of equal funding for EPHS was implemented, and how the costs were distributed across levels of government. Information was collated from funding documents issued by all levels of governments involved, for a sample that includes the central government, 12 provincial governments, eight prefectural governments and 11 county-level governments. For each level of government, we examined: (i) when and how much funding they disbursed or received from higher levels; (ii) when and how much matching funds were made; and (iii) the allocation rules adopted.
Overall, we found the central government met its commitments for the program on time and in full, and good compliance from local governments in passing through funding from higher levels and as well as meeting their own financial responsibilities. However, we also found the following problems: (i) the involvement of so many levels of government resulted in delays in the disbursement of funds; (ii) the use of outdated population data in calculating required funding resulted in some under-allocation; and (iii) localities that needed funding the most were not well targeted by the distribution of funds.
This study traces how the 2018 subsidy for EPHS was disbursed from the central government to service providers, focusing on the roles played by intermediate levels of subnational governments-provinces, prefectures and counties. In this way, it identifies gaps in the current intergovernmental financing of EPHS and points to areas for further improvement.
中国政府于 2009 年启动了医疗改革，并将国家基本公共卫生服务清单（EPHS）作为全民医疗保健计划的一个组成部分。EPHS 也被纳入了全国促进公共服务均等化的计划中。国家为 EPHS 设定了财政投入的国家标准。由于这些服务是由中央和地方政府共同资助的，因此建立一个强大的政府间财政体系对于确保数十万服务提供商有足够的资金来履行服务承诺至关重要。
我们研究了中国复杂的政府间财政体系中的资金流向，以了解 EPHS 均等化资金的承诺是否得到落实，以及成本如何在各级政府之间分配。我们从涉及的各级政府的拨款文件中收集了信息，样本包括中央政府、12 个省级政府、8 个地级市政府和 11 个县级政府。对于每个级别的政府，我们研究了以下内容：（i）他们何时以及从上级那里拨出或收到了多少资金；（ii）何时以及如何筹集配套资金；以及（iii）采用的分配规则。
总体而言，我们发现中央政府按时足额履行了对该计划的承诺，地方政府在向上级传递资金以及履行自身财政责任方面也表现出了良好的合规性。然而，我们也发现了以下问题：（i）涉及如此多层次的政府导致资金的拨付出现延迟；（ii）在计算所需资金时使用过时的人口数据导致了一些分配不足；以及（iii）最需要资金的地方并没有很好地成为资金分配的目标。
本研究追踪了 2018 年 EPHS 补贴从中央政府拨付给服务提供商的情况，重点关注了次国家政府（省、市和县级）在其中所扮演的角色。通过这种方式，它发现了当前 EPHS 政府间融资中的差距，并指出了进一步改进的方向。
