Intra-provincial fiscal decentralisation and healthcare service performance: evidence from China

Sun, Shuo 2023. Intra-provincial fiscal decentralisation and healthcare service performance: evidence from China. PhD Thesis, Cardiff University. Item availability restricted.

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Abstract

Over the past decades, fiscal decentralisation (FD), which refers to the downward transfer of spending responsibilities and revenue sources within the multi-level public sector, has become a global trend. Theories of FD (i.e., fiscal federalism, FF) argue that local governments are more familiar with local demands and have greater advantages in mobilising local resources. Therefore, FD improves public service performance (PSP). However, there is still a lack of empirical evidence for this argument, particularly regarding FD’s impact on healthcare services within Chinese provinces. Using secondary data from China’s 26 provinces from 2006 to 2017, this research addresses the above gap. Moreover, the role of local government capacity (measured by relative wealth) in the relationships between FD and healthcare performance, which is also a key issue highlighted in FD theories, is investigated. This study focuses on two key concepts of PSP: efficiency and effectiveness, and three dimensions of FD: healthcare expenditure decentralisation (HED), total expenditure decentralisation (TED), and revenue decentralisation (RD). It is found that FD from the provincial to the sub-provincial level of government improves healthcare efficiency. Additionally, the benefit of HED for healthcare efficiency may be greater with the increase in government capacity. However, apart from HED, TED and RD are negatively associated with healthcare effectiveness, and such negative relationships fail to be addressed by increasing government capacity. Literature-based discussions suggest that the divergent effects of FD can be attributed to key features of the Chinese-style FD. That is, despite a high level of decentralisation, the performance management system (PMS) in China still follows a top-down pattern. Therefore, to gain tangible benefits such as promotion opportunities, decentralised sub-provincial cadres (e.g. bureaucrats of the local government and the healthcare department) tend to be more accountable for better healthcare efficiency – a key target highlighted by upper-level government leaders. Accordingly, cadres may pay less attention to healthcare effectiveness which is relatively ignored by their superiors. Key words: fiscal decentralisation, healthcare service performance, efficiency, effectiveness, Chinese provinces

Item Type:	Thesis (PhD)
Date Type:	Completion
Status:	Unpublished
Schools:	Business (Including Economics)
Subjects:	H Social Sciences > H Social Sciences (General)
Uncontrolled Keywords:	intra-provincial fiscal decentralisation, healthcare performance, healthcare service efficiency, healthcare service effectiveness, China
Date of First Compliant Deposit:	21 July 2023
Last Modified:	24 Jul 2023 09:10
URI:	https://orca.cardiff.ac.uk/id/eprint/161193

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