發(fā)布時間：2018-03-16 23:16

  本文選題：縣級政府　切入點：醫(yī)療衛(wèi)生支出　出處：《山東大學》2017年碩士論文　論文類型：學位論文

【摘要】：縣級政府是我國政府組織體系的基礎,縣級財政則是基層政府行使自身職能、完善公共服務、推動地區(qū)經(jīng)濟發(fā)展的重要財力保證。而在財政運行過程中,吸引資本、勞動力等流動性資源,謀求政治上的晉升是基層政府做出財政支出決策的重要考量,這其中,政府間財政支出的競爭性發(fā)揮了不容忽視的作用,也是基層官員規(guī)劃各項財政支出的重要依據(jù)。尤其是隨著分權(quán)制改革的深入以及以GDP為核心的政績評價體系的確立,進一步加劇了縣級政府間的橫向比較與競爭。與此同時,由基層政府承擔主要支出責任的教育、醫(yī)療等外部性較強的公共品,由于短期內(nèi)對經(jīng)濟的拉動作用有限而且不是政治考核中的硬約束指標,所以縣級政府也可以通過"搭便車"來享受相鄰地區(qū)的支出外溢。因此,在對醫(yī)療衛(wèi)生服務的需求不斷增長的背景下,實證檢驗縣級政府醫(yī)療衛(wèi)生支出外部性的存在性及其作用機制對規(guī)范政府財政支出秩序、優(yōu)化各級政府支出責任劃分及推動區(qū)域經(jīng)濟協(xié)調(diào)發(fā)展具有重要現(xiàn)實意義。因此,本文在對我國縣級政府醫(yī)療衛(wèi)生支出的相關制度事實及數(shù)理模型進行分析推導的基礎上,首先利用空間計量的方法實證檢驗縣級政府醫(yī)療衛(wèi)生支出外部性的存在性。模型通過構(gòu)造"地理+行政" "地理+經(jīng)濟"矩陣及加入了縱向約束變量的方式,運用System GMM的方法對2002-2006年全國及2009-2014年山東省的縣級政府醫(yī)療衛(wèi)生支出數(shù)據(jù)進行了實證研究。結(jié)果顯示,從同期看,在隸屬于同一地級市及經(jīng)濟發(fā)展水平相近的各縣之間,財政支出競爭是縣級政府間相互影響的主要方式;而從跨期角度看,由于預算的約束及醫(yī)療衛(wèi)生服務的公共品屬性,地理距離相近的縣級政府之間存在醫(yī)療衛(wèi)生支出的跨期外溢效應;另外,以上級政府的轉(zhuǎn)移支付及其醫(yī)療衛(wèi)生支出決策為代表的縱向約束變量也對縣級醫(yī)療衛(wèi)生支出產(chǎn)生了顯著影響。為進一步識別縣級政府間醫(yī)療衛(wèi)生支出競爭的作用機制,本文通過加入農(nóng)業(yè)稅費取消和新一屆全國人大召開時間啞變量的方式,實證檢驗這一競爭性行為到底是來自于爭奪流動性資源的財政競爭,還是基于"自上而下"的標尺競爭機制。結(jié)果顯示,二者在縣級政府的財政運行實踐中均在發(fā)揮作用,其中"自上而下"的標尺競爭機制作用更為強烈;而對于山東這樣的經(jīng)濟大省來說,其競爭更為激烈。根據(jù)上述分析,我們可以發(fā)現(xiàn),政府間的競爭已經(jīng)從經(jīng)濟領域逐漸擴大到醫(yī)療衛(wèi)生等公共服務領域,而在基層財政運行困難的背景下,這一全面競爭的狀態(tài)必然會進一步加大縣級府的支出壓力。由此,本文提出以下政策建議:一是進一步細化醫(yī)療衛(wèi)生支出項目,積極通過政府購買服務、PPP等方式引入市場機制緩解縣級財政的困難;但值得注意的是,要進一步加強對政府融資行為的監(jiān)管,防范地方融資行為的扭曲,包括PPP變相舉債、融資平臺死灰復燃等,推進"可持續(xù)融資"。二是完善各級政府間醫(yī)療衛(wèi)生支出責任的劃分,各級政府的分擔比例應通過法律法規(guī)的形式嚴格確定下來,減少縣級政府支出的隨意性,提高縣級政府的財政能力。三是完善轉(zhuǎn)移支付制度及其監(jiān)管機制,根據(jù)各縣的實際財政能力和需要,合理分配轉(zhuǎn)移支付資金,并提高轉(zhuǎn)移支付的透明度,加強對縣級政府的財力保障力度。四是完善地方官員政績考核、區(qū)域協(xié)同發(fā)展等相關配套制度,從而全方位、多層次的共謀各地區(qū)縣級政府的協(xié)同發(fā)展,推動基層財政的可持續(xù)發(fā)展,為城鎮(zhèn)化的推進及全面建成小康社會積聚力量。
[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.

【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：F812.45

【相似文獻】

相關期刊論文 前10條

1 歐陽志剛;;農(nóng)民醫(yī)療衛(wèi)生支出影響因素的綜列協(xié)整分析[J];世界經(jīng)濟;2007年09期

2 劉曉鳳;;醫(yī)療衛(wèi)生支出與社會公平的動態(tài)相關性研究[J];湖北經(jīng)濟學院學報;2010年01期

3 徐曉飛;楊衛(wèi)華;;我國政府醫(yī)療衛(wèi)生支出相對不足的計量檢驗[J];商業(yè)研究;2014年05期

4 孫健夫,要敬輝;公共財政視角下中國醫(yī)療衛(wèi)生支出分析[J];河北大學學報(哲學社會科學版);2005年03期

5 周美多;金笑馳;;河北省縣級政府醫(yī)療衛(wèi)生支出差異的實證研究——以2007年數(shù)據(jù)為例[J];經(jīng)濟研究導刊;2012年30期

6 劉邦凡;苗桂榮;;略論我國公共醫(yī)療衛(wèi)生支出[J];中國集體經(jīng)濟;2014年06期

7 武劍;方芳;;我國公共醫(yī)療衛(wèi)生支出績效分析[J];開放導報;2007年02期

8 李繼勝;;政府醫(yī)療衛(wèi)生支出的地區(qū)差異測度——基于泰爾指數(shù)的角度[J];中國城市經(jīng)濟;2011年26期

9 李繼勝;;我國區(qū)域公共醫(yī)療衛(wèi)生支出差異的泰爾指數(shù)測度[J];對外經(jīng)貿(mào);2011年12期

10 宋亮;;我國公共醫(yī)療衛(wèi)生支出機制研究[J];中國管理信息化;2012年16期

相關重要報紙文章 前10條

1 見習記者 裘炯華;醫(yī)療衛(wèi)生支出比例高于瑞士等發(fā)達國家[N];醫(yī)藥經(jīng)濟報;2013年

2 譚建偉;公共醫(yī)療衛(wèi)生支出增三成多[N];深圳特區(qū)報;2007年

3 記者 楊惠娟　宋珍;財政用于醫(yī)療衛(wèi)生支出增幅超50%[N];甘肅經(jīng)濟日報;2010年

4 本報記者 李小彤;老齡化加深 醫(yī)衛(wèi)支出增長[N];中國勞動保障報;2011年

5 余芳東;從國際對比看擴大我國居民消費基本路徑[N];中國信息報;2009年

6 黃衛(wèi)華;醫(yī)療衛(wèi)生支出增幅超80%：努力破解看病難題[N];中國稅務報;2007年

7 孔令敏;今年中央財政安排醫(yī)療衛(wèi)生支出逾312億[N];健康報;2007年

8 通訊員 林云　記者 胡笳;港城財政大力傾斜民生[N];連云港日報;2012年

9 柴宴賓;財政部領導來津調(diào)研[N];天津日報;2007年

10 李芙蓉;河北去年民生投入近600億元[N];中國稅務報;2008年

相關博士學位論文 前2條

1 孫玉鳳;政府醫(yī)療衛(wèi)生支出受益歸屬的測算研究[D];山東大學;2016年

2 薩日娜;基于健康人力資本投入視角的財政醫(yī)療衛(wèi)生支出改革研究[D];中國財政科學研究院;2015年

相關碩士學位論文 前10條

1 胡大海;江蘇省各市政府醫(yī)療衛(wèi)生支出效率評價及其影響因素分析[D];蘇州大學;2015年

2 吳震偉;縣級政府醫(yī)療衛(wèi)生支出的問題與對策研究[D];上海交通大學;2014年

3 束洪波;安徽省政府醫(yī)療衛(wèi)生支出效率研究[D];安徽大學;2016年

4 韓文文;我國政府醫(yī)療衛(wèi)生支出的效率及其影響因素研究[D];山東財經(jīng)大學;2016年

5 王晶晶;廣東省政府醫(yī)療衛(wèi)生支出效率研究[D];暨南大學;2016年

6 海萌;醫(yī)療衛(wèi)生支出視域下的河南省減貧效應分析[D];河南大學;2016年

7 喬敏;縣級政府醫(yī)療衛(wèi)生支出的外部性分析[D];山東大學;2017年

8 王煜;中國農(nóng)村居民醫(yī)療衛(wèi)生支出的地區(qū)差異分析[D];浙江工商大學;2008年

9 徐倩;公共財政視角下中國醫(yī)療衛(wèi)生支出現(xiàn)狀及對策研究[D];蘇州大學;2013年

10 戴文君;安徽省財政醫(yī)療衛(wèi)生支出績效實證研究[D];安徽財經(jīng)大學;2016年

，

本文編號：1622111