Who is Paying for Healthcare and School Enrollment? —A Study Based on County-Level Panel Data in China from 2000 to 2023

Zhe Li (), Di Hu, Wushen Huang and Ziyun Wang
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Zhe Li: City University of Macau, Faculty of Finance
Di Hu: City University of Macau, Faculty of Finance
Wushen Huang: City University of Macau, Faculty of Finance
Ziyun Wang: Hainan Vocational University of Science and Technology, School of Accounting

A chapter in Proceedings of the 2026 2nd International Conference on Data Mining and Project Management (DMPM 2026), 2026, pp 70-82 from Springer

Abstract: Abstract This paper proposes a simple unit fiscal burden (UFB) framework to track sector-specific cost dynamics in local public services. Using county-level panel data in China from 2000–2023, we construct UFB measures for healthcare and primary education as sectoral public expenditure per unit of service capacity (hospital beds and primary-school enrollment), expressed in logs. We document a persistent divergence in which expenditure grows much faster than capacity, implying sustained increases in unit burdens. Fixed-effects regressions show that both fiscal capacity (per-capita budget revenue) and fiscal pressure (the expenditure-to-revenue ratio) are positively and significantly associated with UFB in both sectors. Moreover, the association between fiscal capacity and UFB is stronger in high-pressure counties, consistent with tighter budget constraints amplifying cost intensity rather than facilitating proportional capacity expansion. The proposed indicators provide a practical tool for monitoring fiscal risk and service-cost inflation at the local level.

Keywords: County Public Finance; Fiscal Pressure; Healthcare; Compulsory Education; Unit Fiscal Burden (search for similar items in EconPapers)
Date: 2026
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DOI: 10.2991/978-94-6239-689-0_8

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