Abstract: Promoting high-quality medical resources in rural areas is pivotal for solidifying poverty alleviation gains and advancing rural revitalization. Fiscal constraints present a challenge for government at all levels, necessitating a scientifically sound governance model in fiscal departments to optimize fiscal expenditure in medical and health care. This study uses the “County Managing Township Finance” reform as a quasi-natural experiment to study the healthcare market and residents' health under fiscal pressure. The findings of the study are as follows: (1)The reform significantly enhances residents' health. (2)Fiscal pressures and reduced subsidies to public hospitals lower the market entry barriers and average service costs, improving healthcare accessibility and supply-demand alignment. (3)Heterogeneity analysis finds that the reform benefits rural residents more notably. This study provides a reference for how to enhance local healthcare capacities amid fiscal constraints.

Key words: Local Fiscal Governance, Fiscal Expenditure, Residents' Health, “County Managing Township Finance” Reform

摘要： 推动优质医疗资源下沉农村是巩固脱贫成果、推动乡村振兴的重要落脚点。财政运行紧平衡是各级财政当下及未来一段时期需要面对的现状,科学合理的基层财政治理模式是提高财政对医疗卫生投入效益的制度性保障。本文以“乡财县管”改革为准自然实验,探讨了财政运行紧平衡背景下的医疗卫生市场与居民健康水平。研究发现:(1)“乡财县管”改革显著改善了改革县居民的健康状况;(2)改革后,随着财政压力的增加以及财政对医疗机构补贴力度的下降,医疗市场的准入门槛以及医疗服务的平均价格显著降低,医疗可及性以及医疗服务供需匹配程度得到改善,最终改革地区居民健康状况得到显著改善;(3)异质性研究发现,“乡财县管”改革的健康改善作用,主要体现在农村居民群体中。本文为我国如何在财政紧平衡下推动优质医疗资源下沉、提升基层医疗服务能力提供了参考与借鉴。

关键词: 基层财政治理, 财政支出, 居民健康, 乡财县管