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Fiscal Decentralization, Local Competitions and Sustainability of Medical Insurance Funds: Evidence from China

机译：财政分权，地方竞争与医疗保险基金的可持续性：来自中国的证据

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摘要

Local governments are responsible for the management of social medical insurance for urban and rural residents in China. Under the background of fiscal decentralization between the central government and local governments, the strengthening of supervision on medical insurance funds by local governments leads to a reduction in the expenditure of the medical insurance fund, which contributes to its sustainability. By employing the provincial level panel data during 2004–2014, we used a fixed effect model and a spatial autoregression model to investigate whether fiscal decentralization has had a negative influence on the expenditure of China’s new rural cooperative medical system (NCMS) fund. We found that fiscal decentralization has had a significant influence over its per capita expenditure. Our results also indicate that higher fiscal decentralization leads to higher financial aid in the NCMS provided by local governments. Additionally, the expenditure of the NCMS and the local financial aid are influenced by nearby governments. Our results suggest that appropriate fiscal decentralization, which helps to maintain the sustainability of social medical insurance funds, should be encouraged.
机译：地方政府负责中国城乡居民的社会医疗保险管理。在中央政府和地方政府之间财政分权的背景下，地方政府加强对医疗保险基金的监管导致医疗保险基金支出的减少，从而有助于其可持续性。通过使用2004-2014年的省级面板数据，我们使用固定效应模型和空间自回归模型来研究财政分权是否对中国新型农村合作医疗制度（NCMS）基金的支出产生了负面影响。我们发现，财政分权对其人均支出产生了重大影响。我们的结果还表明，更高的财政分权会导致地方政府在新农合中提供更高的财政援助。此外，新农合和地方财政援助的支出受到附近政府的影响。我们的结果表明，应该鼓励适当的财政分权，这有助于维持社会医疗保险基金的可持续性。

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