Cui Yanyin, Ren Jie, Gao Xupeng, Xia Fang
School of Humanities and Management, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
School of Management, Changchun University of Chinese Medicine, Changchun, Jilin, China.
Front Public Health. 2025 Mar 21;13:1454088. doi: 10.3389/fpubh.2025.1454088. eCollection 2025.
In driving a transition in environmental governance, China's low-carbon city pilot (LCCP) policy has exerted a dichotomous impact on public health expenditure that is characterized by both a decline in relative proportion and expansion of absolute scale. Research to date is insufficient for understanding the transmission mechanisms and policy coordination pathways underlying this contradiction, which has hindered the sustainable realization of environmental health benefits. This study thus investigates the impact of China's LCCP policy on public health expenditure and the underlying mechanisms involved.
Based on panel data of 285 Chinese cities at the prefecture level and above from 2003 to 2019, a quasi-natural experiment was conducted using China's LCCP policy. The time-varying difference-in-differences simulation method and hierarchical regression method were used to analyze the effect and mechanism of the LCCP policy on China's public health expenditure.
The results demonstrate the inherently paradoxical nature of the effects of the LCCP policy on public health expenditure: although the LCCP policy produces a significant relative reduction in public health expenditure ( = -0.331, < 0.001), it simultaneously produces a pronounced expansion in terms of absolute expenditure ( = 0.409, < 0.001). These impacts are spatially heterogeneous across regions and exhibit supply-demand divergence in healthcare infrastructure readiness and environmental threshold effects that are contingent upon pollution severity gradients. Further analysis of the underlying mechanism reveals that public low-carbon behaviors serve as dual negative mediators in both expenditure dimensions, whereas household medical burdens exert a significant positive mediating effect on absolute expenditure but a statistically insignificant mediating effect on relative expenditure.
This study reveals the complex synergistic mechanisms linking environmental governance to health investment allocation. The internal contradictory effects of the LCCP policy on public health expenditures must be resolved by striking a balance between environmental governance and health investment, implementing regional differentiation strategies, optimizing the structure of preventive expenditures, and guiding the public to collaborative participation. China's environmental quality and public health should be promoted simultaneously.
在推动环境治理转型过程中，中国的低碳城市试点（LCCP）政策对公共卫生支出产生了双重影响，其特点是相对比例下降而绝对规模扩大。迄今为止的研究不足以理解这一矛盾背后的传导机制和政策协调路径，这阻碍了环境健康效益的可持续实现。因此，本研究考察了中国LCCP政策对公共卫生支出的影响及相关潜在机制。
基于2003年至2019年中国285个地级及以上城市的面板数据，利用中国的LCCP政策进行了一项准自然实验。采用时变差分模拟方法和分层回归方法分析LCCP政策对中国公共卫生支出的影响及机制。
结果表明LCCP政策对公共卫生支出的影响具有内在矛盾性：尽管LCCP政策使公共卫生支出相对显著减少（β = -0.331，p < 0.001），但同时在绝对支出方面却有显著扩张（β = 0.409，p < 0.001）。这些影响在各地区存在空间异质性，并且在医疗基础设施准备情况和环境阈值效应方面呈现出供需差异，这取决于污染严重程度梯度。对潜在机制的进一步分析表明，公众低碳行为在两个支出维度上均作为双重负向中介变量，而家庭医疗负担对绝对支出有显著正向中介效应，但对相对支出的中介效应在统计上不显著。
本研究揭示了将环境治理与健康投资分配联系起来的复杂协同机制。必须通过在环境治理与健康投资之间取得平衡、实施区域差异化战略、优化预防性支出结构以及引导公众协同参与，来解决LCCP政策对公共卫生支出的内部矛盾效应。应同时促进中国的环境质量和公众健康。
