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Inter-provincial inequality of public health services in China: the perspective of local officials’ behavior

BACKGROUND: After economic reform, China experienced rising public health services inequality between the eastern developed and mid-west undeveloped provinces. The fiscal transfer payment system which aims to shape the disparities was considered inefficient. However, there are only a few studies tha...

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Autores principales: Chen, Tianxiang, Wang, Ying, Luo, Xiaoyi, Rao, Yuxuan, Hua, Lei
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6069573/
https://www.ncbi.nlm.nih.gov/pubmed/30064429
http://dx.doi.org/10.1186/s12939-018-0827-8
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author Chen, Tianxiang
Wang, Ying
Luo, Xiaoyi
Rao, Yuxuan
Hua, Lei
author_facet Chen, Tianxiang
Wang, Ying
Luo, Xiaoyi
Rao, Yuxuan
Hua, Lei
author_sort Chen, Tianxiang
collection PubMed
description BACKGROUND: After economic reform, China experienced rising public health services inequality between the eastern developed and mid-west undeveloped provinces. The fiscal transfer payment system which aims to shape the disparities was considered inefficient. However, there are only a few studies that address the political reason when analyzing the inter-provincial public health services inequality. And the previous studies did not consider a possible non-linear relationship between the fiscal transfer payments and the inter-provincial public health services equalization. METHODS: This paper argues that the local officials’ fanatical pursuit of local economic growth which driven by the Political Promotion Tournament and the polarized fiscal self-sufficiency (fiscal capacities) of local governments are responsible for the inter-provincial inequality of public health services and the inefficiency of fiscal transfer payments. By constructing panel threshold regression models with fiscal self-sufficiency of local governments as threshold variable, this study tries to empirically investigate the optimal level of the local governments’ self-sufficiency at which the fiscal transfer payments can effectively promote equalization. RESULTS: Threshold effects exist between fiscal transfer payments and inter-provincial public health services equalization. The effects on inter-provincial public health services equalization show trends that first increase and then decrease as the fiscal self-sufficiency of local governments increases. And there exist a range of fiscal self-sufficiency between 29.236 and 43.765% or between 28.575 and 45.746% for local governments where the fiscal transfer payments can effectively achieve equalization. Currently, the vast majority of provinces in China remain in the ineffective regime where the fiscal transfer payments are inefficient in shaping inequality. CONCLUSIONS: This paper explains the reason of inequality in public health services and the inefficiency of fiscal transfer payment system from Chinese local officials’ behavior aspect, and try to find out an effective solution by focusing on the local government’s fiscal capacity. The effective way to narrow the inequality is to establish a flexible tax-sharing system to adjust local governments’ fiscal capacities and give local governments with low fiscal self-sufficiency more fiscal resources. The new policy measures recently launched by Chinese central government coincide with our recommendations.
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spelling pubmed-60695732018-08-03 Inter-provincial inequality of public health services in China: the perspective of local officials’ behavior Chen, Tianxiang Wang, Ying Luo, Xiaoyi Rao, Yuxuan Hua, Lei Int J Equity Health Research BACKGROUND: After economic reform, China experienced rising public health services inequality between the eastern developed and mid-west undeveloped provinces. The fiscal transfer payment system which aims to shape the disparities was considered inefficient. However, there are only a few studies that address the political reason when analyzing the inter-provincial public health services inequality. And the previous studies did not consider a possible non-linear relationship between the fiscal transfer payments and the inter-provincial public health services equalization. METHODS: This paper argues that the local officials’ fanatical pursuit of local economic growth which driven by the Political Promotion Tournament and the polarized fiscal self-sufficiency (fiscal capacities) of local governments are responsible for the inter-provincial inequality of public health services and the inefficiency of fiscal transfer payments. By constructing panel threshold regression models with fiscal self-sufficiency of local governments as threshold variable, this study tries to empirically investigate the optimal level of the local governments’ self-sufficiency at which the fiscal transfer payments can effectively promote equalization. RESULTS: Threshold effects exist between fiscal transfer payments and inter-provincial public health services equalization. The effects on inter-provincial public health services equalization show trends that first increase and then decrease as the fiscal self-sufficiency of local governments increases. And there exist a range of fiscal self-sufficiency between 29.236 and 43.765% or between 28.575 and 45.746% for local governments where the fiscal transfer payments can effectively achieve equalization. Currently, the vast majority of provinces in China remain in the ineffective regime where the fiscal transfer payments are inefficient in shaping inequality. CONCLUSIONS: This paper explains the reason of inequality in public health services and the inefficiency of fiscal transfer payment system from Chinese local officials’ behavior aspect, and try to find out an effective solution by focusing on the local government’s fiscal capacity. The effective way to narrow the inequality is to establish a flexible tax-sharing system to adjust local governments’ fiscal capacities and give local governments with low fiscal self-sufficiency more fiscal resources. The new policy measures recently launched by Chinese central government coincide with our recommendations. BioMed Central 2018-07-31 /pmc/articles/PMC6069573/ /pubmed/30064429 http://dx.doi.org/10.1186/s12939-018-0827-8 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Chen, Tianxiang
Wang, Ying
Luo, Xiaoyi
Rao, Yuxuan
Hua, Lei
Inter-provincial inequality of public health services in China: the perspective of local officials’ behavior
title Inter-provincial inequality of public health services in China: the perspective of local officials’ behavior
title_full Inter-provincial inequality of public health services in China: the perspective of local officials’ behavior
title_fullStr Inter-provincial inequality of public health services in China: the perspective of local officials’ behavior
title_full_unstemmed Inter-provincial inequality of public health services in China: the perspective of local officials’ behavior
title_short Inter-provincial inequality of public health services in China: the perspective of local officials’ behavior
title_sort inter-provincial inequality of public health services in china: the perspective of local officials’ behavior
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6069573/
https://www.ncbi.nlm.nih.gov/pubmed/30064429
http://dx.doi.org/10.1186/s12939-018-0827-8
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