关键词: 县级政府, 医疗卫生支出, 外部性

Abstract: Under the system of fiscal decentralization, the competition between the supply of public goods among local governments has become an important part of regional competition. This paper chooses as the topic the medical service which is closely related to the public welfare but is rarely mentioned in existing literatures, and uses the spatial econometric model to estimate the existence and types of the externalities of county-level governments' medical expenditure. The results of the study are as follows: The complementary strategy is the main strategy for the medical and health competition among county-level governments, which belong to the same prefecture-level city and whose economic development is at similar level; across the horizon, there is a policy alternative to health care spending among county-level governments with similar geographical distances. This paper further examines whether the external liquidity of medical and health services originates from the fiscal competition for resources or from the “top-down” yardstick competition. The study finds that compared with the fiscal competition, the “top-down” yardstick competition has a greater impact on the medical and health competition services among county-level governments.

Key words: County Government, Medical Expenditure, Externality