Inter-provincial inequality of public health services in China: the perspective of local officials' behavior.
Inter-provincial inequality of public health services in China: the perspective of local officials' behavior.
复制标题
中国公共卫生服务的省外不平等：地方官员行为的观点。
DOI：
10.1186/s12939-018-0827-8
复制
发表时间：
2018-07-31
影响因子：
4.8
通讯作者：
Hua L
中科院分区：
文献类型：
--
作者：
Chen T;Wang Y;Luo X;Rao Y;Hua L
经济改革后，我国东部发达省份与中西部欠发达省份之间的公共卫生服务不平等现象日益严重。旨在缩小差距的财政转移支付制度被认为效率低下。然而，在分析我国省际公共卫生服务不平等的过程中，只有少数研究涉及到政治原因。而以往的研究并未考虑财政转移支付与省际公共卫生服务均等化之间可能存在的非线性关系。本文认为，地方官员在“政治晋升锦标赛”驱动下对地方经济增长的狂热追求和地方政府财政自给（财政能力）的两极分化是造成省际间公共卫生服务不平等和财政转移支付效率低下的主要原因。通过构建以地方政府财政自给率为门槛变量的面板门槛回归模型，实证研究了地方政府财政转移支付能够有效促进均等化的最优自给率水平。财政转移支付与省际公共卫生服务均等化之间存在门槛效应。随着地方政府财政自给能力的提高，省际公共卫生服务均等化的影响呈现出先增大后减小的趋势。地方政府的财政自给率在29.236%~ 43.765%和28.575%~ 45.746%之间，财政转移支付能够有效地实现均等化。目前，我国绝大多数省份仍处于财政转移支付对不平等形成的无效机制中。本文从地方政府行为的角度解释了我国公共卫生服务不平等和财政转移支付制度效率低下的原因，并试图从地方政府的财政能力角度寻求有效的解决途径。缩小这种不平等的有效途径是建立灵活的分税制，调整地方政府的财政能力，使财政自给能力较低的地方政府获得更多的财政资源。中国中央政府最近推出的新政策措施与我们的建议不谋而合。
After economic reform, China experienced rising public health services inequality between the eastern developed and mid-west undeveloped provinces. The fiscal transfer payment system which aims to shape the disparities was considered inefficient. However, there are only a few studies that address the political reason when analyzing the inter-provincial public health services inequality. And the previous studies did not consider a possible non-linear relationship between the fiscal transfer payments and the inter-provincial public health services equalization. This paper argues that the local officials’ fanatical pursuit of local economic growth which driven by the Political Promotion Tournament and the polarized fiscal self-sufficiency (fiscal capacities) of local governments are responsible for the inter-provincial inequality of public health services and the inefficiency of fiscal transfer payments. By constructing panel threshold regression models with fiscal self-sufficiency of local governments as threshold variable, this study tries to empirically investigate the optimal level of the local governments’ self-sufficiency at which the fiscal transfer payments can effectively promote equalization. Threshold effects exist between fiscal transfer payments and inter-provincial public health services equalization. The effects on inter-provincial public health services equalization show trends that first increase and then decrease as the fiscal self-sufficiency of local governments increases. And there exist a range of fiscal self-sufficiency between 29.236 and 43.765% or between 28.575 and 45.746% for local governments where the fiscal transfer payments can effectively achieve equalization. Currently, the vast majority of provinces in China remain in the ineffective regime where the fiscal transfer payments are inefficient in shaping inequality. This paper explains the reason of inequality in public health services and the inefficiency of fiscal transfer payment system from Chinese local officials’ behavior aspect, and try to find out an effective solution by focusing on the local government’s fiscal capacity. The effective way to narrow the inequality is to establish a flexible tax-sharing system to adjust local governments’ fiscal capacities and give local governments with low fiscal self-sufficiency more fiscal resources. The new policy measures recently launched by Chinese central government coincide with our recommendations.
登录
查看更多内容
影响因子：
3.2
作者：
Elwell-Sutton, Timothy M.;Jiang, Chao Qiang;Schooling, C. M.
通讯作者：
Schooling, C. M.
影响因子：
3.5
作者：
Baeten, Steef;Van Ourti, Tom;van Doorslaer, Eddy
通讯作者：
van Doorslaer, Eddy
影响因子：
6.8
作者：
LAMPTON, DM
通讯作者：
LAMPTON, DM
区域健康不平等及其决定因素：来自中国的证据
影响因子：
3.3
作者：
Fang, Pengqian;Dong, Siping;Wang, Yiping
通讯作者：
Wang, Yiping
影响因子：
3.1
作者：
Han, Chunping
通讯作者：
Han, Chunping