县级政府医疗卫生支出的外部性分析

发布时间：2018-03-16 23:16

本文选题：县级政府　切入点：医疗卫生支出　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：县级政府是我国政府组织体系的基础,县级财政则是基层政府行使自身职能、完善公共服务、推动地区经济发展的重要财力保证。而在财政运行过程中,吸引资本、劳动力等流动性资源,谋求政治上的晋升是基层政府做出财政支出决策的重要考量,这其中,政府间财政支出的竞争性发挥了不容忽视的作用,也是基层官员规划各项财政支出的重要依据。尤其是随着分权制改革的深入以及以GDP为核心的政绩评价体系的确立,进一步加剧了县级政府间的横向比较与竞争。与此同时,由基层政府承担主要支出责任的教育、医疗等外部性较强的公共品,由于短期内对经济的拉动作用有限而且不是政治考核中的硬约束指标,所以县级政府也可以通过"搭便车"来享受相邻地区的支出外溢。因此,在对医疗卫生服务的需求不断增长的背景下,实证检验县级政府医疗卫生支出外部性的存在性及其作用机制对规范政府财政支出秩序、优化各级政府支出责任划分及推动区域经济协调发展具有重要现实意义。因此,本文在对我国县级政府医疗卫生支出的相关制度事实及数理模型进行分析推导的基础上,首先利用空间计量的方法实证检验县级政府医疗卫生支出外部性的存在性。模型通过构造"地理+行政" "地理+经济"矩阵及加入了纵向约束变量的方式,运用System GMM的方法对2002-2006年全国及2009-2014年山东省的县级政府医疗卫生支出数据进行了实证研究。结果显示,从同期看,在隶属于同一地级市及经济发展水平相近的各县之间,财政支出竞争是县级政府间相互影响的主要方式;而从跨期角度看,由于预算的约束及医疗卫生服务的公共品属性,地理距离相近的县级政府之间存在医疗卫生支出的跨期外溢效应;另外,以上级政府的转移支付及其医疗卫生支出决策为代表的纵向约束变量也对县级医疗卫生支出产生了显著影响。为进一步识别县级政府间医疗卫生支出竞争的作用机制,本文通过加入农业税费取消和新一届全国人大召开时间哑变量的方式,实证检验这一竞争性行为到底是来自于争夺流动性资源的财政竞争,还是基于"自上而下"的标尺竞争机制。结果显示,二者在县级政府的财政运行实践中均在发挥作用,其中"自上而下"的标尺竞争机制作用更为强烈;而对于山东这样的经济大省来说,其竞争更为激烈。根据上述分析,我们可以发现,政府间的竞争已经从经济领域逐渐扩大到医疗卫生等公共服务领域,而在基层财政运行困难的背景下,这一全面竞争的状态必然会进一步加大县级府的支出压力。由此,本文提出以下政策建议:一是进一步细化医疗卫生支出项目,积极通过政府购买服务、PPP等方式引入市场机制缓解县级财政的困难;但值得注意的是,要进一步加强对政府融资行为的监管,防范地方融资行为的扭曲,包括PPP变相举债、融资平台死灰复燃等,推进"可持续融资"。二是完善各级政府间医疗卫生支出责任的划分,各级政府的分担比例应通过法律法规的形式严格确定下来,减少县级政府支出的随意性,提高县级政府的财政能力。三是完善转移支付制度及其监管机制,根据各县的实际财政能力和需要,合理分配转移支付资金,并提高转移支付的透明度,加强对县级政府的财力保障力度。四是完善地方官员政绩考核、区域协同发展等相关配套制度,从而全方位、多层次的共谋各地区县级政府的协同发展,推动基层财政的可持续发展,为城镇化的推进及全面建成小康社会积聚力量。
[Abstract]:County government is the basis of government organization system in China, the county finance is the grass-roots government to exercise their functions, improve public services, an important financial guarantee to promote regional economic development. And in the process of financial operation, to attract capital, resources and labor mobility, for political promotion treatment is an important consideration, make local government finance spending decisions which, inter governmental fiscal expenditure competition played a role can not be ignored, but also an important basis for the planning of the grass-roots officials of fiscal expenditure. Especially with the establishment of decentralization reform as well as GDP is the core of the performance evaluation system, further exacerbating the horizontal comparison and competition among the county governments. At the same time from the government at the grass-roots level, bear the main responsibility of the expenditure of education, medical and other external public goods because of strong, stimulating effect on the economy in the short term but not limited Hard constraints in the political assessment index, so the county government can also use "free rider" to enjoy the adjacent areas of expenditure spillover. Therefore, the demand of medical service under the background of increasing, the empirical test of county government health expenditure externalities and its mechanism of regulating the government fiscal expenditure order optimization all levels of government expenditure responsibilities and has important practical significance to promote the coordinated development of regional economy. Therefore, this paper carries on the health expenditure of our county government institutional facts and analysis of mathematical models derived on the basis of the existence of empirical test of county government health expenditure externalities by using the spatial econometrics model by constructing. "Geography + administration" geography + economy "matrix and joined the longitudinal constraint variables, using the method of System GMM in the 2002-2006 years And 2009-2014 years in Shandong Province, the county government health expenditure data and empirical research. The results showed that from the same period, in which belong to the same cities and counties close to the level of economic development, fiscal expenditure competition is the main way of mutual influence among the county governments; and from the intertemporal perspective, due to budget constraints the medical and health service of the public goods attribute, the intertemporal spillover effect exists between the county government health expenditure close geographical distance; in addition, higher levels of government transfer payments and health expenditure decision as the representative of the longitudinal constraint variables also have a significant influence on the medical expenditure. For the mechanism of health expenditure competition further identification of county government, through adding abolishing the agricultural tax and the new session of the National People's Congress held time dummy variables, the empirical test of this. What is the competitive behavior from competing for the mobility of resources or financial competition, based on the "top-down" yardstick competition mechanism. The results show that two in the county government's financial operation practice all play a role in the role of "top-down yardstick competition mechanism" is more intense; and for such a large economic province in Shandong speaking, the competition is more intense. According to the above analysis, we can find that the government competition has from the economic field gradually expanded to the field of medical health and other public services, and in the grass-roots finance difficulty under the background of the overall competition state will further increase the county government expenditure pressure. Therefore, put forward the following policy suggestions: one is to further refine the health expenditure project, actively through the government purchase of services, PPP and other ways to introduce the market mechanism to alleviate the county financial difficulties; but worthy of note It is, to further strengthen the supervision of government financing behavior, financing behavior against local distortions, including PPP disguise debt financing platform to promote sustainable financing a stirring among the dry bones, ". The two is to improve the division of health expenditure responsibilities between levels of government, governments at all levels should share in the form of laws and regulations strictly determined the county government spending down, reduce the randomness, improve the financial capacity of the county government. The three is to improve the transfer payment system and supervision mechanism, according to the actual needs of county financial capacity and reasonable allocation, transfer payments, transfer payments and improve transparency, strengthen the county government's financial security efforts. The four is to improve the local officials the performance evaluation of regional cooperative development and related supporting system, and all-round, coordinated development of multi-level common regions of the county government, local finance can promote Continuous development has accumulated power for the promotion of urbanization and the building of a well-off society in an all-round way.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：F812.45

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