Abstract: Based on the panel data of government health expenditures in 285 cities in China from 2007 to 2018, the article examines the strategic interactive behavior of government health expenditures among prefecture-level cities by constructing a general dynamic spatial Dubin model and a two-zone spatial Dubin model. The results of the study are as follows: First, there is a significant “competitive upward” strategic interaction behavior of government health expenditure behavior among prefecture-level cities in China, that is, the city's government health expenditure level will go up with the increase of neighboring government expenditure levels. Second, the competition for health expenditure among more developed cities is more intense. The space spillover effect between ordinary cities has inhibited the expansion of government health expenditure. The research in this article implies that the positive strategic interaction between local governments on health expenditure has a positive significance for the continuous promotion of equalization of basic medical and health services. And how to do a good job in the promotion of the system design and performance evaluation, targeted incentives, especially the willingness of the local governments in underdeveloped regions,to compete for health and other “people's financial” expenditure are the core and key to optimize the structure of local fiscal expenditure.

Key words: Public Health Expenditure, Financial Competition, Spatial Dubin Model

摘要： 文章基于2007～2018年间中国285个城市的政府卫生支出面板数据,通过构建一般动态空间杜宾模型和两区制空间杜宾模型,检验了城市政府卫生支出的策略性互动行为并得出以下结论:第一,我国城市政府的卫生支出行为存在显著的“竞争向上”的策略性互动行为,其支出规模会随着邻区政府支出水平的提高而增长。第二,经济相对发达城市间的卫生支出竞争程度更为激烈,而空间溢出作用抑制了普通城市间的政府卫生支出水平进一步扩大。文章研究认为,地方政府间对卫生支出规模形成的正向互动行为,对于持续推进基本医疗卫生服务均等化具有重要意义。而如何做好晋升机制与政绩考核等方面的制度设计,针对性的激励特别是欠发达地区的地方政府对医疗卫生等“民生财政”支出的竞争意愿,是优化地方财政支出结构的核心和关键。

关键词: 政府卫生支出, 财政竞争, 空间杜宾模型