School of Economics, Zhejiang University, Hangzhou 310027, China.
Int J Environ Res Public Health. 2023 Jan 23;20(3):2060. doi: 10.3390/ijerph20032060.
Improving fiscal health expenditure efficiency is an inherent requirement of the strategy of "healthy China" and "high-quality development". The outbreak of COVID-19 has highlighted the importance of efficient health system. First, this paper systematically sorts out the multiple theoretical mechanisms of the positive and negative relationship between vertical fiscal imbalance and fiscal health expenditure efficiency. Secondly, a comprehensive index system, including the quantity and quality of medical services, is constructed, and the super-efficiency DEA model is used to measure fiscal health expenditure efficiency. There are obvious differences between eastern and western regions. Finally, the fixed effect model is constructed to carry out empirical research and it is found that the vertical fiscal imbalance in China has an overall positive and significant impact on the fiscal health expenditure efficiency, which is mainly achieved by optimizing the resources allocation between primary medical institutions and hospitals. Heterogeneity analysis shows that transfer payment scale has a corrective effect on the vertical fiscal imbalance's effect. The result of quantile regression shows that the impact of vertical fiscal imbalance is not constant, and it gradually turns from positive to negative along with the improvement of fiscal health expenditure efficiency.
提高财政医疗卫生支出效率是“健康中国”和“高质量发展”战略的内在要求。新冠肺炎疫情的爆发凸显了高效卫生系统的重要性。首先，本文系统梳理了纵向财政失衡与财政医疗卫生支出效率之间正、负相关的多种理论机制。其次，构建了包括医疗服务数量和质量在内的综合指标体系，并采用超效率 DEA 模型测算了财政医疗卫生支出效率，发现东西部地区存在明显差异。最后，构建固定效应模型进行实证研究，结果表明，中国纵向财政失衡对财政医疗卫生支出效率具有整体正向且显著的影响，主要是通过优化基层医疗机构和医院之间的资源配置来实现的。异质性分析表明，转移支付规模对纵向财政失衡的影响具有矫正作用。分位数回归结果表明，纵向财政失衡的影响并非一成不变，而是随着财政医疗卫生支出效率的提高逐渐由正转负。
