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

【摘要】：縣級政府是我國政府組織體系的基礎(chǔ),縣級財政則是基層政府行使自身職能、完善公共服務(wù)、推動地區(qū)經(jīng)濟(jì)發(fā)展的重要財力保證。而在財政運(yùn)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(xiàng)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(jìn)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(dān)主要支出責(zé)任的教育、醫(yī)療等外部性較強(qiáng)的公共品,由于短期內(nèi)對經(jīng)濟(jì)的拉動作用有限而且不是政治考核中的硬約束指標(biāo),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(wù)的需求不斷增長的背景下,實(shí)證檢驗(yàn)縣級政府醫(yī)療衛(wèi)生支出外部性的存在性及其作用機(jī)制對規(guī)范政府財政支出秩序、優(yōu)化各級政府支出責(zé)任劃分及推動區(qū)域經(jīng)濟(jì)協(xié)調(diào)發(fā)展具有重要現(xiàn)實(shí)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(guān)制度事實(shí)及數(shù)理模型進(jìn)行分析推導(dǎo)的基礎(chǔ)上,首先利用空間計量的方法實(shí)證檢驗(yàn)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(jì)"矩陣及加入了縱向約束變量的方式,運(yùn)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(jìn)行了實(shí)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(jì)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(yù)算的約束及醫(yī)療衛(wèi)生服務(wù)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(yīng);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(jìn)一步識別縣級政府間醫(yī)療衛(wèi)生支出競爭的作用機(jī)制,本文通過加入農(nóng)業(yè)稅費(fèi)取消和新一屆全國人大召開時間啞變量的方式,實(shí)證檢驗(yàn)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(biāo)尺競爭機(jī)制。結(jié)果顯示,二者在縣級政府的財政運(yùn)行實(shí)踐中均在發(fā)揮作用,其中"自上而下"的標(biāo)尺競爭機(jī)制作用更為強(qiáng)烈;而對于山東這樣的經(jīng)濟(jì)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(jì)領(lǐng)域逐漸擴(kuò)大到醫(yī)療衛(wèi)生等公共服務(wù)領(lǐng)域,而在基層財政運(yùn)行困難的背景下,這一全面競爭的狀態(tài)必然會進(jìn)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(jìn)一步細(xì)化醫(yī)療衛(wèi)生支出項(xiàng)目,積極通過政府購買服務(wù)、PPP等方式引入市場機(jī)制緩解縣級財政的困難;但值得注意的是,要進(jìn)一步加強(qiáng)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(fù)燃等,推進(jìn)"可持續(xù)融資"。二是完善各級政府間醫(yī)療衛(wèi)生支出責(zé)任的劃分,各級政府的分擔(dān)比例應(yīng)通過法律法規(guī)的形式嚴(yán)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(jī)制,根據(jù)各縣的實(shí)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(qiáng)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(guān)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(jìn)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(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：F812.45

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