健康中国背景下的“看病贵”与政府支出——基于资源配置结构性失衡视角的分析.

Expensive medical treatment(“Kan Bing Gui” in Chinese)refers to the high cost of converting medical and health resources into medical and health services, and the quantity and quality of medical and health service supply under limited resources are difficult to meet public health needs, thus directly affecting the construction of Healthy China Initiative. Moreover, the explosive growth in healthcare demand brought by the rapid aging of China's population will create additional pressure on the healthcare system and exacerbate the mismatch between supply and demand. Consequently, solving the “Kan Bing Gui” problem is a crucial task to ensure the achievement of the goals of the Healthy China Initiative. Many related studies simply attribute the “Kan Bing Gui” problem to insufficient fiscal expenditure on health, which is inconsistent with the fact and lacks in-depth analysis of the underlying institutional mechanisms behind the problem. Based on the perspective of structural imbalance in the allocation of medical and health resources, this paper studies the relationship between “Kan Bing Gui” problem and fiscal expenditure on health. Firstly, by summarizing the characteristic facts, we condense two main theoretical hypotheses:(1)The imbalanced allocation of medical and health resources is a major contributor to the “Kan Bing Gui” problem;(2)An increase in fiscal expenditure on health will aggravate the structural imbalance in the allocation of medical and health resources and hinder the alleviation of the “Kan Bing Gui” problem. Secondly, we empirically confirm the above two hypotheses with provincial panel data from 2009 to 2019, using Feasible Generalized Least Squares(FGLS)and mediation testing. Finally, we conclude that increasing fiscal expenditure on health will ultimately worsen the structural imbalance in the allocation of human resources, which is not conducive to solving the “Kan Bing Gui” problem. For the sake of truly alleviating the “Kan Bing Gui” problem from the whole society, increasing fiscal expenditure on health should be combined with in-depth reforms of the health care system to fundamentally optimize the allocation of medical and health resources, and then improve allocative efficiency. Compared to existing literature, this paper has three contributions. Firstly, we analyze the “Kan Bing Gui” problem at social level rather than just at an individual or family level. Although the long-term high total cost of social health is difficult to be perceived by the public and has strong concealment, it directly affects the implementation of the Healthy China Initiative. Secondly, this paper is based on the imbalanced allocation of medical and health resources, and mainly concentrates on the structural imbalance in the referral system. We explore the institutional factors of the “Kan Bing Gui” problem by analyzing the underlying causes of the imbalanced allocation of medical and health resources. This paper can provide a theoretical basis for fundamentally solving the “Kan Bing Gui” problem and correctly understanding the government expenditure responsibility. Thirdly, this paper delves deeper into the coordination mechanisms between efficient market and effective government to achieve a rational allocation of medical and health resources. This paper proposes a new idea to solve the “Kan Bing Gui” problem by fully coordinating the tripartite mechanism of the government, market and society, and combine the increasing of government health expenditure with the deepen reform of health care system. “Kan Bing Gui” has been a long-standing issue in China. In recent years, various kinds of studies have examined the causes of this problem, but this paper provides a unique perspective to explore the impact of structural imbalance in referral systems on this problem, as well as the systematic mechanisms behind the problem, and also puts forward useful ideas and references for the construction of the Healthy China Initiative. [ABSTRACT FROM AUTHOR]