IDEAS home Printed from https://ideas.repec.org/a/gam/jsusta/v11y2019i8p2437-d225631.html
   My bibliography  Save this article

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

Author

Listed:
  • Wenqiang Qian

    (The Co-Innovation Center for Social Governance of Urban and Rural Communities in Hubei Province, Zhongnan University of Economics and Law, Wuhan 430073, China
    School of Public Administration, Zhongnan University of Economics and Law, Wuhan 430073, China)

  • Xiangyu Cheng

    (The Co-Innovation Center for Social Governance of Urban and Rural Communities in Hubei Province, Zhongnan University of Economics and Law, Wuhan 430073, China)

  • Guoying Lu

    (The Co-Innovation Center for Social Governance of Urban and Rural Communities in Hubei Province, Zhongnan University of Economics and Law, Wuhan 430073, China
    School of Public Administration, Zhongnan University of Economics and Law, Wuhan 430073, China)

  • Lijun Zhu

    (The Co-Innovation Center for Social Governance of Urban and Rural Communities in Hubei Province, Zhongnan University of Economics and Law, Wuhan 430073, China
    School of Public Administration, Zhongnan University of Economics and Law, Wuhan 430073, China)

  • Fei Li

    (Research Center for Environment and Health, Zhongnan University of Economics and Law, Wuhan 430073, China)

Abstract

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.

Suggested Citation

  • Wenqiang Qian & Xiangyu Cheng & Guoying Lu & Lijun Zhu & Fei Li, 2019. "Fiscal Decentralization, Local Competitions and Sustainability of Medical Insurance Funds: Evidence from China," Sustainability, MDPI, vol. 11(8), pages 1-21, April.
  • Handle: RePEc:gam:jsusta:v:11:y:2019:i:8:p:2437-:d:225631
    as

    Download full text from publisher

    File URL: https://www.mdpi.com/2071-1050/11/8/2437/pdf
    Download Restriction: no

    File URL: https://www.mdpi.com/2071-1050/11/8/2437/
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Li, Hongbin & Zhou, Li-An, 2005. "Political turnover and economic performance: the incentive role of personnel control in China," Journal of Public Economics, Elsevier, vol. 89(9-10), pages 1743-1762, September.
    2. Baltagi, Badi H. & Moscone, Francesco, 2010. "Health care expenditure and income in the OECD reconsidered: Evidence from panel data," Economic Modelling, Elsevier, vol. 27(4), pages 804-811, July.
    3. David Prieto & Santiago Lago-Peñas, 2012. "Decomposing the determinants of health care expenditure: the case of Spain," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(1), pages 19-27, February.
    4. Qian, Yingyi & Roland, Gerard, 1998. "Federalism and the Soft Budget Constraint," American Economic Review, American Economic Association, vol. 88(5), pages 1143-1162, December.
    5. Brock, Gregory & Jin, Yinghua & Zeng, Tong, 2015. "Fiscal decentralization and China's regional infant mortality," Journal of Policy Modeling, Elsevier, vol. 37(2), pages 175-188.
    6. Joan Costa-Font & Ana Rico, 2006. "Vertical Competition in the Spanish National Health System (NHS)," Public Choice, Springer, vol. 128(3), pages 477-498, September.
    7. Chen, Ye & Li, Hongbin & Zhou, Li-An, 2005. "Relative performance evaluation and the turnover of provincial leaders in China," Economics Letters, Elsevier, vol. 88(3), pages 421-425, September.
    8. Joseph P. Newhouse, 1992. "Medical Care Costs: How Much Welfare Loss?," Journal of Economic Perspectives, American Economic Association, vol. 6(3), pages 3-21, Summer.
    9. David E. Bloom & Roddy McKinnon, 2010. "Introduction: Social security and the challenge of demographic change," PGDA Working Papers 6110, Program on the Global Demography of Aging.
    10. Fubing Su & Ran Tao & Lu Xi & Ming Li, 2012. "Local Officials' Incentives and China's Economic Growth: Tournament Thesis Reexamined and Alternative Explanatory Framework," China & World Economy, Institute of World Economics and Politics, Chinese Academy of Social Sciences, vol. 20(4), pages 1-18, July.
    11. Li, Xin & Guh, Daphne & Lacaille, Diane & Esdaile, John & Anis, Aslam H., 2007. "The impact of cost sharing of prescription drug expenditures on health care utilization by the elderly: Own- and cross-price elasticities," Health Policy, Elsevier, vol. 82(3), pages 340-347, August.
    12. Andreas Werblow & Stefan Felder & Peter Zweifel, 2007. "Population ageing and health care expenditure: a school of ‘red herrings’?," Health Economics, John Wiley & Sons, Ltd., vol. 16(10), pages 1109-1126, October.
    13. Matthew E. Kahn & Pei Li & Daxuan Zhao, 2015. "Water Pollution Progress at Borders: The Role of Changes in China's Political Promotion Incentives," American Economic Journal: Economic Policy, American Economic Association, vol. 7(4), pages 223-242, November.
    14. Jin Feng & Pingyi Lou & Yangyang Yu, 2015. "Health Care Expenditure over Life Cycle in the People's Republic of China," Asian Development Review, MIT Press, vol. 32(1), pages 167-195, March.
    15. Atella, Vincenzo & Conti, Valentina, 2014. "The effect of age and time to death on primary care costs: The Italian experience," Social Science & Medicine, Elsevier, vol. 114(C), pages 10-17.
    16. Fukushima, Kazuya & Mizuoka, Sou & Yamamoto, Shunsuke & Iizuka, Toshiaki, 2016. "Patient cost sharing and medical expenditures for the Elderly," Journal of Health Economics, Elsevier, vol. 45(C), pages 115-130.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Feng, Suling & Sui, Bo & Liu, Huimin & Li, Guoxiang, 2020. "Environmental decentralization and innovation in China," Economic Modelling, Elsevier, vol. 93(C), pages 660-674.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Luo, Kun & Lim, Edwin KiaYang & Qu, Wen & Zhang, Xuan, 2021. "Board cultural diversity, government intervention and corporate innovation effectiveness: Evidence from China," Journal of Contemporary Accounting and Economics, Elsevier, vol. 17(2).
    2. Eberhardt, Markus & Wang, Zheng & Yu, Zhihong, 2016. "From one to many central plans: Drug advertising inspections and intra-national protectionism in China," Journal of Comparative Economics, Elsevier, vol. 44(3), pages 608-622.
    3. Wu, Mingqin & Cao, Xun, 2021. "Greening the career incentive structure for local officials in China: Does less pollution increase the chances of promotion for Chinese local leaders?," Journal of Environmental Economics and Management, Elsevier, vol. 107(C).
    4. Jing Wu & Hao Li & Keyang Li, 2020. "Local political chief turnover and economic growth: Evidence from China," Economics of Transition and Institutional Change, John Wiley & Sons, vol. 28(3), pages 441-466, July.
    5. Yu, Jihai & Zhou, Li-An & Zhu, Guozhong, 2016. "Strategic interaction in political competition: Evidence from spatial effects across Chinese cities," Regional Science and Urban Economics, Elsevier, vol. 57(C), pages 23-37.
    6. Xuhong Su & Kelan Lu & Xiangming Hu & Yuqiong Xiang, 2019. "Reforms on county-level fiscal governance in China: impact on urban-rural income inequality," International Review of Public Administration, Taylor & Francis Journals, vol. 24(2), pages 81-100, April.
    7. Pei Li & Yi Lu & Tuan-Heww Sng, 2017. "Artificial Administrative Boundaries: Evidence from China," CEH Discussion Papers 09, Centre for Economic History, Research School of Economics, Australian National University.
    8. Luca Grassetti & Laura Rizzi, 2019. "The determinants of individual health care expenditures in the Italian region of Friuli Venezia Giulia: evidence from a hierarchical spatial model estimation," Empirical Economics, Springer, vol. 56(3), pages 987-1009, March.
    9. Liu, Guy S. & Sun, Pei & Wing Thye Woo, 2007. "What motivates and constrains politicians to privatize? The case of China," Economics Letters, Elsevier, vol. 97(1), pages 81-86, October.
    10. Yi Long & Chris Nyland & Russell Smyth, 2016. "Fiscal Decentralisation, the Knowledge Economy and School Teachers’ Wages in Urban China," Monash Economics Working Papers 13-16, Monash University, Department of Economics.
    11. Chen, Xiude & Qin, Quande & Wei, Y.-M., 2016. "Energy productivity and Chinese local officials’ promotions: Evidence from provincial governors," Energy Policy, Elsevier, vol. 95(C), pages 103-112.
    12. Peter Willemé & Michel Dumont, 2016. "Machines that go ‘ping’: Medical Technology and Health Expenditures in OECD Countries," Health Economics, John Wiley & Sons, Ltd., vol. 25(3), pages 387-388, March.
    13. He, Guojun & Xie, Yang & Zhang, Bing, 2020. "Expressways, GDP, and the environment: The case of China," Journal of Development Economics, Elsevier, vol. 145(C).
    14. Xia Chen & Qiang Cheng & Ying Hao & Qiang Liu, 2020. "GDP growth incentives and earnings management: evidence from China," Review of Accounting Studies, Springer, vol. 25(3), pages 1002-1039, September.
    15. Chen, Yvonne Jie & Li, Pei & Lu, Yi, 2018. "Career concerns and multitasking local bureaucrats: Evidence of a target-based performance evaluation system in China," Journal of Development Economics, Elsevier, vol. 133(C), pages 84-101.
    16. Huiming Zhang & Lifang Xiong & Yueming Qiu & Dequn Zhou, 2017. "How Have Political Incentives for Local Officials Reduced Environmental Pollution in Resource-Depleted Cities?," Sustainability, MDPI, vol. 9(11), pages 1-14, October.
    17. Jin, Gang & Shen, Kunrong & Li, Jian, 2020. "Interjurisdiction political competition and green total factor productivity in China: An inverted-U relationship," China Economic Review, Elsevier, vol. 61(C).
    18. Julan Du & Hongsheng Fang & Xiangrong Jin, 2013. "Chinese Political and Economic Governance System and the Imbalance between Consumption and Investment," Working Papers 232013, Hong Kong Institute for Monetary Research.
    19. Yihua Yu & Li Zhang & Fanghua Li & Xinye Zheng, 2013. "Strategic interaction and the determinants of public health expenditures in China: a spatial panel perspective," The Annals of Regional Science, Springer;Western Regional Science Association, vol. 50(1), pages 203-221, February.
    20. Norton, E.C., 2016. "Health and Long-Term Care," Handbook of the Economics of Population Aging, in: Piggott, John & Woodland, Alan (ed.), Handbook of the Economics of Population Aging, edition 1, volume 1, chapter 0, pages 951-989, Elsevier.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:gam:jsusta:v:11:y:2019:i:8:p:2437-:d:225631. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: . General contact details of provider: https://www.mdpi.com .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: MDPI Indexing Manager (email available below). General contact details of provider: https://www.mdpi.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.