Keywords
Local government debt;
Fiscal sustainability;
Medical and health service capacity;
Total dependency ratio
Abstract
This article aims to explore the impact mechanism, multidimensional effects, and heterogeneity characteristics of medical and health expenditure on local government debt in China. Following the methodology of quantitative research, China's provincial regions are selected as the research objects, and the balanced panel data of 31 provincial regions in China from 2016 to 2022 are used as the research materials. The two-way fixed effects model is used to analyze the proposed problems. The empirical findings are as follows. (1) During the observed development period, medical and health expenditure has a significant promoting effect on local government debt in China. (2) The impact of medical and health expenditure on local government debt in China exhibits significant regional heterogeneity, with a negative effect in developed areas such as the eastern region and a positive effect in underdeveloped areas such as the central, western, and northeastern regions of China. (3) The total dependency ratio and medical and health service capacity have a positive moderating effect on the impact of medical and health expenditure on local government debt in China. The improvement of the total dependency ratio and medical and health service capacity will exacerbate the local government debt pressure in China caused by medical and health expenditure. This research provides specific policy implications for balancing medical and health expenditure with local government debt management and promoting the sustainable development of the local economy and society.
References
Cao, M. Y., Duan, K. Y., Cao, M. Y., & Ibrahim, H. (2023). Exploring the interrelationships between public health, fiscal decentralization, and local government debt in China. Healthcare, 11(14), Article 2103. https://doi.org/10.3390/healthcare11142103
Chen, B. Q., & Jin, F. L. (2022). Spatial distribution, regional differences, and dynamic evolution of the medical and health services supply in China. Frontiers in Public Health, 10, Article 1020402. https://doi.org/10.3389/fpubh.2022.1020402
Christopoulos, K., & Eleftheriou, K. (2020). The fiscal impact of health care expenditure: Evidence from the OECD countries. Economic Analysis and Policy, 67. https://doi.org/10.1016/j.eap.2020.07.010
Coccia, M., & Benati, I. (2024). Negative effects of high public debt on health systems facing pandemic crisis: Lessons from COVID-19 in Europe to prepare for future emergencies. AIMS Public Health, 11(2). https://doi.org/10.3934/publichealth.2024024
Fu, L. P., Sun, H. J., Meng, Y., & Li, J. X. (2022). The role of public-private partnerships in local government debt Is a potential threat to sustainable cities: A case from China. Sustainability, 14(21), Article 13972. https://doi.org/10.3390/su142113972
Huo, X. L., Bi, S. L., & Yin, Y. S. (2023). The impact of fiscal decentralization and intergovernmental competition on the local government debt risk: Evidence from China. Frontiers in Environmental Science, 11, Article 1103822. https://doi.org/10.3389/fenvs.2023.1103822
Joseph, P., Wim, G., & Milena, P. (2024). Determinants of public health expenditure in the EU. PLoS ONE, 19(3), Article e0299359. https://doi.org/10.1371/journal.pone.0299359
Kamiguchi, A., & Tamai, T. (2019). Public investment, public debt, and population aging under the golden rule of public finance. Journal of Macroeconomics, 60. https://doi.org/10.1016/j.jmacro.2019.01.011
Leach, M. J., Walsh, S., Muyambi, K., Gillam, M., & Jones, M. (2020). Expressed demand for health care services in regional South Australia: A cross-sectional study. The Journal of Rural Health, 37(3). https://doi.org/10.1111/jrh.12472
Li, S., & Qi, T. C. (2023). Fiscal decentralization, local government debt, and corporate innovation. Finance Research Letters, 54, Article 103764. https://doi.org/10.1016/j.frl.2023.103764
Liu, Y., Mai, L. X., Huang, F., & Zeng, Z. Y. (2024). Regional healthcare resource allocation and decision-making: Evaluating the effectiveness of the three-stage super-efficiency DEA model. Heliyon, 10(23), Article e40312. https://doi.org/10.1016/j.heliyon.2024.e40312
Lone, T. A., Zeba, S., Javaid, A. D., & Lone, P. A. (2021). Does health expenditure affect health outcomes? A cointegration based approach to the Indian healthcare system. International Journal of Behavioural and Healthcare Research, 7(3), Article 114809. https://doi.org/10.1504/ijbhr.2021.114809
Lone, T. A., & Lone, P. A. (2022). Does fiscal deficit, public debt, economic growth and energy consumption affect health expenditure in India: An empirical evidence based ARDL bound testing approach. International Journal of Happiness and Development, 7(1), Article 124164. https://doi.org/10.1504/ijhd.2022.124164
Pan, H. R., & Wang, C. (2012). Government debt in the euro area—Evidence from dynamic factor analysis. Economics Letters, 115(2). https://doi.org/10.1016/j.econlet.2011.12.084
Piligrimienė, Z. (2012). Measurement issues in health care service quality. Economics and Management, 17(1), 2280. https://doi.org/10.5755/j01.em.17.1.2280
Said, R., & Morai, A. S. (2020). Relationship between public debt burden and health expenditure in sub-Saharan African countries: The role of institutional quality. Journal of Business and Social Review in Emerging Economies, 6(2), 1092. https://doi.org/10.26710/jbsee.v6i2.1092
Sun, J. T., & Yu, Q. J. (2023). Adhering to the Health China Strategy and sharing the fruits of health equity. International Journal of Frontiers in Sociology, 5(2). https://francis-press.com/papers/9412
Tian, Y. F., Xu, Z. S., & Wang, X. X. (2024). The impact of economic growth on health resource allocation in China: Based on a PVAR dynamic analysis. Journal of Social and Economic Development. Advance online publication. https://doi.org/10.1007/s40847-024-00384-y
Wang, J. L., Liu, Y., Wang, W. L., & Wu, H. T. (2023). Effects of Chinese-style fiscal decentralization on carbon emissions: Is there a role for urban construction investment bonds? Economic Research-Ekonomska Istraživanja, 36(3), Article 2158115. https://doi.org/10.1080/1331677X.2022.2158115
Wang, L. G., Zhao, H. X., Liu, J. W., He, T. Y., Zhu, H., & Liu, Y. M. (2024). How does the digital economy affect carbon emissions from tourism? Empirical evidence from China. Journal of Cleaner Production, 469, Article 143175. https://doi.org/10.1016/j.jclepro.2024.143175
Wang, N. (2024). The temporal and spatial interpretation of China’s health financing: What do Chinese’ government ‘do’ in new healthcare reform. Health Economics Review, 14, Article 00551. https://doi.org/10.1186/s13561-024-00551-1
Wang, T. Q., Zhou, T., Zhou, L. M., He, Y. F., Wang, J., Wang, Y. H., & Huang, L. (2024). Equity and efficiency of health resource allocation in the Chengdu–Chongqing Economic Circle of China. Frontiers in Public Health, 12, Article 1369568. https://doi.org/10.3389/fpubh.2024.1369568
Wang, X. Y. (2023). Effect measurement and system optimization of special debt in promoting high-quality development of local economy. Advances in Politics and Economics, 7(2), 211. https://doi.org/10.22158/ape.v7n2p211
Wang, X. Y., He, T. Y., Wang, S. Z., & Zhao, H. X. (2025). The impact of artificial intelligence on economic growth from the perspective of population external system. Social Science Computer Review, 43(1), 129–147. https://doi.org/10.1177/08944393241246100
Wen, B. H., Xu, J. X., Zhang, L., Hao, J., & Zhang, Z. Y. (2024). Spatial correlation of local government implicit debt tail risks in China and its spillover effects on the banking system. International Review of Financial Analysis, 96, Article 103609. https://doi.org/10.1016/j.irfa.2024.103609
Yang, C. R., Cui, D., Yin, S. C., Wu, R. N., Ke, X. F., Liu, X. J., Yang, Y., Sun, Y. X., Xu, L. X. Y., & Teng, C. X. (2022). Fiscal autonomy of subnational governments and equity in healthcare resource allocation: Evidence from China. Frontiers in Public Health, 10, Article 989625. https://doi.org/10.3389/fpubh.2022.989625
Yang, X. Y., Li, N., Mu, H. L., Ahmad, M., & Meng, X. Y. (2022). Population aging, renewable energy budgets and environmental sustainability: Does health expenditures matter. Gondwana Research, 106. https://doi.org/10.1016/j.gr.2022.02.003
Yao, D. W., Yu, R. Y., & Zhang, R. (2023). Whether the distribution of medical resources among provinces is balanced. International Journal of Frontiers in Medicine, 5, Article 050502. https://doi.org/10.25236/ijfm.2023.050502
Ye, Y. Z., & Tao, Q. S. (2023). Measurement and characteristics of the temporal-spatial evolution of China’s healthcare services efficiency. Archives of Public Health, 81(1), Article 12. https://doi.org/10.1186/s13690-023-01208-x
Yu, S. M., Wan, K., Liu, W. J., Wang, D. L., Zheng, J. Y., & Dong, B. Y. (2024). The crowding out effect of local government debt expansion: Insights from commercial credit financing. Economic Analysis and Policy, 83. https://doi.org/10.1016/j.eap.2024.07.001
Zhao, H., Liu, J., Bai, T., Peng, X., Yuan, Y., Shi, R., & Cui, Y. (2026). Urban cooling effects of China’s low-carbon city policy: Causal evidence from satellite-derived urban heat islands. Energy Policy, 213, Article 115351. https://doi.org/10.1016/j.enpol.2026.115351
Zhao, Z. Y., & Cai, Y. H. (2024). Research on the spatial differences and network structure of economic development in the Yangtze River Belt, China. Sustainability, 16(12), Article 5023. https://doi.org/10.3390/su16125023
Zheng, C. J., Huang, S. W., & Qian, N. Y. (2020). Analysis of the co-movement between local government debt risk and bank risk in China. The Singapore Economic Review, 66(3). https://doi.org/10.1142/s0217590819500632
Zhu, J., Zhu, M., & Yang, Z. W. (2024). The financialization of local government debt in China and its risk transmission to commercial banks. Economic Modelling, 133, Article 106687. https://doi.org/10.1016/j.econmod.2024.106687
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