财政分权下地方政府卫生支出的竞争行为研究
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摘要
分权体制框架下地级市政府在制定医疗卫生支出决策时往往会受到相邻城市相关策略的影响,从而引发城市间政府卫生支出的策略互动行为。文章选取了2007-2013年中国283个城市面板数据,运用动态空间面板模型检验了分权体制下地市级政府卫生支出的策略互动行为,并揭示出财政分权及其城市间空间策略互动对政府卫生支出的影响。研究发现,地市级政府在政府卫生支出上存在显著的互补型策略互动,这种效应在地理距离相近的同省区城市间更为显著。进一步分析发现,财政分权促进了政府卫生服务供给;而无论是短期还是长期,地市级政府间财政分权的策略互动对政府卫生支出产生明显的抑制作用,从而较好地解释了政府卫生支出比重徘徊不前的原因。由此,积极利用竞争、激励机制以及实现财政体制安排的优化变革来引导政府的卫生服务供给将是重要的政策选择。
Medical and health services concerns the well-being of people. It is fundamental for promoting the construction of China's people-centered health strategy and realizing the development for the benefit of all. This study proposes a theoretical model of yardstick competition "from the top" and discusses the existence of inter-city tactful interaction behaviors in healthcare spending among prefectural-level municipal governments within the framework of a decentralized system. Very often, healthcare spending decisions made by prefectural-level municipal governments are influenced by the relevant strategies of the neighboring cities.Based on the data from 283 prefectural-level cities in China from 2007–2013, and using the dynamic spatial Durbin model(SDM), empirical tests are performed at the prefectural level to investigate the effects of interactions between cities within the same province, as well as the impacts of fiscal decentralization and its spatial tactful interactions in healthcare spending. We conclude that significant strategic interactions exist among municipal governments in government healthcare spending. Furthermore, the strategic interaction of government healthcare spending belongs to complementarities. This indicates that if the adjacent municipal government raises the level of healthcare spending in the same province, the city government's optimal strategy will be to increase the level of government health spending accordingly, with cities characterized by geographical proximity and competing more strongly for government healthcare spending. Moreover, fiscal decentralization seems to drive the supply of government health services, as tactful interactions tend to limit government health spending. This explains why the share of government health spending has been hovering at around 2%. Overall, the implementation of competitive or incentive mechanisms and optimized financial arrangements emerge as a truly effective policy to stimulate the supply of government health services. The potential contributions of this paper are as follows. Firstly, in theoretical research, considering welfare maximization decision-making under the restriction of limited resources, this paper develops a "topdown" competition model for government healthcare spending between municipal governments using the interaction theory framework. Secondly, the dynamic spatial Durbin model(SDM) is used to solve the "path dependence" characteristics of government healthcare spending and to ease the problem of "endogeneity". The research conclusion is more accurate after a comprehensive consideration of government healthcare spending over time, space, and time-space lag effects. Thirdly, based on a panel data of 283 prefectural-level cities from2007–2013, this paper projects a micro and accurate description of the competing behaviors of prefecturallevel city governments. Finally, from a research perspective, this paper contributes practical value by examining the strategic interactions in government healthcare spending behaviors, and shows the short-and long-term effects of fiscal decentralization and the strategic competition for space in government healthcare spending.
Medical and health services concerns the well-being of people. It is fundamental for promoting the construction of China's people-centered health strategy and realizing the development for the benefit of all. This study proposes a theoretical model of yardstick competition "from the top" and discusses the existence of inter-city tactful interaction behaviors in healthcare spending among prefectural-level municipal governments within the framework of a decentralized system. Very often, healthcare spending decisions made by prefectural-level municipal governments are influenced by the relevant strategies of the neighboring cities.Based on the data from 283 prefectural-level cities in China from 2007–2013, and using the dynamic spatial Durbin model(SDM), empirical tests are performed at the prefectural level to investigate the effects of interactions between cities within the same province, as well as the impacts of fiscal decentralization and its spatial tactful interactions in healthcare spending. We conclude that significant strategic interactions exist among municipal governments in government healthcare spending. Furthermore, the strategic interaction of government healthcare spending belongs to complementarities. This indicates that if the adjacent municipal government raises the level of healthcare spending in the same province, the city government's optimal strategy will be to increase the level of government health spending accordingly, with cities characterized by geographical proximity and competing more strongly for government healthcare spending. Moreover, fiscal decentralization seems to drive the supply of government health services, as tactful interactions tend to limit government health spending. This explains why the share of government health spending has been hovering at around 2%. Overall, the implementation of competitive or incentive mechanisms and optimized financial arrangements emerge as a truly effective policy to stimulate the supply of government health services. The potential contributions of this paper are as follows. Firstly, in theoretical research, considering welfare maximization decision-making under the restriction of limited resources, this paper develops a "topdown" competition model for government healthcare spending between municipal governments using the interaction theory framework. Secondly, the dynamic spatial Durbin model(SDM) is used to solve the "path dependence" characteristics of government healthcare spending and to ease the problem of "endogeneity". The research conclusion is more accurate after a comprehensive consideration of government healthcare spending over time, space, and time-space lag effects. Thirdly, based on a panel data of 283 prefectural-level cities from2007–2013, this paper projects a micro and accurate description of the competing behaviors of prefecturallevel city governments. Finally, from a research perspective, this paper contributes practical value by examining the strategic interactions in government healthcare spending behaviors, and shows the short-and long-term effects of fiscal decentralization and the strategic competition for space in government healthcare spending.
引文
[1]冯海波,陈旭佳.公共医疗卫生支出财政均等化水平的实证考察--以广东省为样本的双变量泰尔指数分析[J].财贸经济,2009,(11):49-53.
[2]傅勇.财政分权、政府治理与非经济性公共物品供给[J].经济研究,2010,(8):4-15.
[3]郭庆旺,贾俊雪.地方政府间策略互动行为、财政支出竞争与地区经济增长[J].管理世界,2009,(10):17-27.
[4]贾俊雪.政府间财政收支责任安排与地方公共服务均等化:实证研究[J].中国软科学,2011,(12):35-45.
[5]贾俊雪,应世为.财政分权与企业税收激励--基于地方政府竞争视角的分析[J].中国工业经济,2016,(10):23-39.
[6]李涛,周业安.中国地方政府间支出竞争研究--基于中国省级面板数据的经验证据[J].管理世界,2009,(2):12-22.
[7]李郇,洪国志,黄亮雄.中国土地财政增长之谜--分税制改革、土地财政增长的策略性[J].经济学(季刊),2013,(3):1141-1160.
[8]陆铭.城市、区域和国家发展--空间政治经济学的现在与未来[J].经济学(季刊),2017,(4):1499-1532.
[9]肖海翔,刘乐帆,邵彩霞.中国政府卫生支出的最优规模及其实现[J].中国社会科学院研究生院学报,2011,(4):26-32.
[10]肖海翔,刘乐帆.政府卫生支出规模的影响因素研究--基于中国省级面板数据的实证分析[J].中国社会科学院研究生院学报,2013,(2):44-52.
[11]王晓洁.中国公共卫生支出均等化水平的实证分析--基于地区差别视角的量化分析[J].财贸经济,2009,(2):46-49.
[12]王萱.我国政府卫生支出最优规模的实证研究[J].中国卫生经济,2013,(11):47-48.
[13]张曙霄,戴永安.异质性、财政分权与城市经济增长--基于面板分位数回归模型的研究[J].金融研究,2012,(1):103-115.
[14]周黎安.中国地方官员的晋升锦标赛模式研究[J].经济研究,2007,(7):36-50.
[15]周亚虹,宗庆庆,陈曦明.财政分权体制下地市级政府教育支出的标尺竞争[J].经济研究,2013,(11):127-139.
[16]Atella V,Belotti F,Depalo D,et al.Measuring spatial effects in the presence of institutional constraints:The case of Italian local health authority expenditure[J].Regional Science and Urban Economics,2014,(49):232-241.
[17]Besley T,Case A.Incumbent behavior:Vote-seeking,tax-setting,and yardstick competition[J].American Economic Review,1995,85(1):25-45.
[18]Caldeira E.Yardstick competition in a federation:Theory and evidence from China[J].China Economic Review,2012,23(4):878-897.
[19]Chou W L.Explaining China’s regional health expenditures using LM-type unit root tests[J].Journal of Health Economics,2007,26(4):682-698.
[20]Elhorst J P,Fréret S.Evidence of political yardstick competition in France using a two-regime spatial Durbin model with fixed effects[J].Journal of Regional Science,2009,48(5):931-951.
[21]Elhorst J P.Dynamic spatial panels:Models,methods and inferences[J].Journal of Geographical Systems,2012,14(1):5-28.
[22]Elhorst J P,da Silva D F C,da Mota Silveira Neto R.A spatial economic model and spatial econometric analysis of population dynamics in Brazilian MCAs[R].Conference Paper,Lisbon,Portugal,2015.
[23]Greene W.Distinguishing between heterogeneity and inefficiency:Stochastic frontier analysis of the world health organization’s panel data on national health care systems[J].Health Economics,2004,13(10):959-980.
[24]Gupta S,Verhoeven M.The efficiency of government expenditure:Experiences from Africa[J].Journal of Policy Modeling,2001,23(4):433-467.
[25]Halleck Vega S,Elhorst J P.The SLX model[J].Journal of Regional Science,2015,55(3):339-363.
[26]Lee L F,Yu J.Estimation of spatial autoregressive panel data models with fixed effects[J].Journal of Econometrics,2010,154(2):165-185.
[27]Le Sage J P,Pace R K.Introduction to spatial econometrics[M].CRC Press/Taylor&Francis Group:London,2009.
[28]Matteo L,Matteo R.Evidence on the determinants of Canadian provincial government health expenditures:1965-1991[J].Journal of Health Economics,1998,17(2):211-228.
(1)基于地理距离考察范围内任何两地区间的相关性,相关强度随距离增大而加速减弱,服从地理学第一定律。
(1)限于篇幅,本文未报告详细的检验结果,欢迎读者索要。
[2]傅勇.财政分权、政府治理与非经济性公共物品供给[J].经济研究,2010,(8):4-15.
[3]郭庆旺,贾俊雪.地方政府间策略互动行为、财政支出竞争与地区经济增长[J].管理世界,2009,(10):17-27.
[4]贾俊雪.政府间财政收支责任安排与地方公共服务均等化:实证研究[J].中国软科学,2011,(12):35-45.
[5]贾俊雪,应世为.财政分权与企业税收激励--基于地方政府竞争视角的分析[J].中国工业经济,2016,(10):23-39.
[6]李涛,周业安.中国地方政府间支出竞争研究--基于中国省级面板数据的经验证据[J].管理世界,2009,(2):12-22.
[7]李郇,洪国志,黄亮雄.中国土地财政增长之谜--分税制改革、土地财政增长的策略性[J].经济学(季刊),2013,(3):1141-1160.
[8]陆铭.城市、区域和国家发展--空间政治经济学的现在与未来[J].经济学(季刊),2017,(4):1499-1532.
[9]肖海翔,刘乐帆,邵彩霞.中国政府卫生支出的最优规模及其实现[J].中国社会科学院研究生院学报,2011,(4):26-32.
[10]肖海翔,刘乐帆.政府卫生支出规模的影响因素研究--基于中国省级面板数据的实证分析[J].中国社会科学院研究生院学报,2013,(2):44-52.
[11]王晓洁.中国公共卫生支出均等化水平的实证分析--基于地区差别视角的量化分析[J].财贸经济,2009,(2):46-49.
[12]王萱.我国政府卫生支出最优规模的实证研究[J].中国卫生经济,2013,(11):47-48.
[13]张曙霄,戴永安.异质性、财政分权与城市经济增长--基于面板分位数回归模型的研究[J].金融研究,2012,(1):103-115.
[14]周黎安.中国地方官员的晋升锦标赛模式研究[J].经济研究,2007,(7):36-50.
[15]周亚虹,宗庆庆,陈曦明.财政分权体制下地市级政府教育支出的标尺竞争[J].经济研究,2013,(11):127-139.
[16]Atella V,Belotti F,Depalo D,et al.Measuring spatial effects in the presence of institutional constraints:The case of Italian local health authority expenditure[J].Regional Science and Urban Economics,2014,(49):232-241.
[17]Besley T,Case A.Incumbent behavior:Vote-seeking,tax-setting,and yardstick competition[J].American Economic Review,1995,85(1):25-45.
[18]Caldeira E.Yardstick competition in a federation:Theory and evidence from China[J].China Economic Review,2012,23(4):878-897.
[19]Chou W L.Explaining China’s regional health expenditures using LM-type unit root tests[J].Journal of Health Economics,2007,26(4):682-698.
[20]Elhorst J P,Fréret S.Evidence of political yardstick competition in France using a two-regime spatial Durbin model with fixed effects[J].Journal of Regional Science,2009,48(5):931-951.
[21]Elhorst J P.Dynamic spatial panels:Models,methods and inferences[J].Journal of Geographical Systems,2012,14(1):5-28.
[22]Elhorst J P,da Silva D F C,da Mota Silveira Neto R.A spatial economic model and spatial econometric analysis of population dynamics in Brazilian MCAs[R].Conference Paper,Lisbon,Portugal,2015.
[23]Greene W.Distinguishing between heterogeneity and inefficiency:Stochastic frontier analysis of the world health organization’s panel data on national health care systems[J].Health Economics,2004,13(10):959-980.
[24]Gupta S,Verhoeven M.The efficiency of government expenditure:Experiences from Africa[J].Journal of Policy Modeling,2001,23(4):433-467.
[25]Halleck Vega S,Elhorst J P.The SLX model[J].Journal of Regional Science,2015,55(3):339-363.
[26]Lee L F,Yu J.Estimation of spatial autoregressive panel data models with fixed effects[J].Journal of Econometrics,2010,154(2):165-185.
[27]Le Sage J P,Pace R K.Introduction to spatial econometrics[M].CRC Press/Taylor&Francis Group:London,2009.
[28]Matteo L,Matteo R.Evidence on the determinants of Canadian provincial government health expenditures:1965-1991[J].Journal of Health Economics,1998,17(2):211-228.
(1)基于地理距离考察范围内任何两地区间的相关性,相关强度随距离增大而加速减弱,服从地理学第一定律。
(1)限于篇幅,本文未报告详细的检验结果,欢迎读者索要。