纵向财政失衡、FDI竞争与医疗卫生服务供给水平——兼论标尺竞争机制下地区间的策略性行为北大核心CSSCI

关于医疗卫生服务供给不足的原因一直是社会各界高度关注的重点话题,现行的财政分权制度常被认为是最主要的原因。本文尝试将表征现行财政分权制度特征的三个要素,即纵向财政失衡、地区FDI竞争和地区间竞争模仿的策略性行为,与医疗卫生服务供给水平纳入同一分析框架,在对其理论机制分析的基础上,利用2007-2018年277个地级及以上城市面板数据,实证考察它们之间的关系特征及机制路径。研究发现,纵向财政失衡与地区FDI竞争对医疗卫生服务供给水平均存在显著的抑制作用,同时,地区FDI竞争对纵向财政失衡的负向抑制作用具有正向调节效应。进一步分析发现,地方政府间的标尺竞争使其在医疗卫生服务供给行为上表现出明显的策略模仿,医疗卫生服务供给水平呈明显的空间溢出效应。异质性分析发现,发达地区医疗卫生服务供给水平受抑制的主因是FDI竞争所致,欠发达地区则主要缘于纵向财政失衡的显著影响。机制分析发现,纵向财政失衡通过作用于财政支出结构与医疗卫生支出效率两种方式实现对医疗卫生服务供给水平的抑制,而FDI竞争则主要是通过扭曲财政支出结构的方式实现其抑制作用。本文的研究丰富了医疗卫生服务供给不足制度性成因探寻的文献,对于如何全面推进新一轮财税体制改革、深化医疗卫生体制改革、优化政绩考核指标等具有借鉴意义。

Vertical Financial Imbalance,FDI Competition and Supply Level of Medical and Health Services:On the Strategic Behavior of Regions under the Yardstick Competition Mechanism

The reason for the insufficient supply of medical and health services has always been a key topic of great concern to all sectors of society,and the current fiscal decentralization system is often considered as the most important reason.This paper attempts to combine the three elements that characterize the current fiscal decentralization system,namely,vertical fiscal imbalance,regional FDI competition and the strategy of regional competitive imitation,into the same analytical framework with the level of medical and health service supply.On the basis of discussing its theoretical mechanism,this paper empirically investigates their relationship and mechanism by using the panel data of 277 prefecture-level cities and above on the Chinese mainland from 2007 to 2018.Empirical research shows that both vertical fiscal imbalance and regional FDI competition have significant inhibitory effects on the supply level of medical and health services.Meanwhile,regional FDI competition has a positive regulatory effect on the negative inhibitory effect of vertical financial imbalance.Further analysis shows that the yardstick competition among local governments encourages obvious strategy imitation in medical and health service supply,and the level of medical and health service supply shows an obvious spatial spillover effect.Heterogeneity analysis shows that the main reason for the suppression of health service supply level in developed areas is FDI competition,while in underdeveloped areas it is mainly due to the significant impact of vertical fiscal imbalance.Mechanism analysis shows that vertical fiscal imbalance can restrain the supply level of medical and health services by acting on the structure of financial expenditure and the efficiency of medical and health expenditure,while FDI competition can restrain it mainly by distorting the structure of financial expenditure.The research in this paper enriches the literature on the institutional causes of insufficient supply of medical and health services,and has reference value on how to comprehensively promote the latest round of fiscal and taxation reform,deepen the reform of medical and health system,and optimize performance evaluation indicators.