[main points]

1. "the God of Wealth follows the God of plague". The "God of Wealth" is the related input, and the "God of plague" is a major epidemic. Judging from past experience, investment will increase significantly as a result of greater attention during or after a major epidemic.

2. "God of plague" is a sprint, while "God of Wealth" is a long-distance race. Major outbreaks tend to have a long interval and a short duration. The investment in prevention and control needs to be persisted in the long term, and there is no effect in the short term. When the main goal of the government's work is still economic growth, whether the "God of Wealth" can persist in long-distance running becomes a question.

3. In the era of stock economy, the difficulty of the long-distance running of "God of Wealth" increases rather than decreases. The decline in the growth rate of public revenue will inevitably make it more difficult for the medical and health sector to "divide the cake". By the end of 2018, the proportion of public health expenditure in a considerable number of provinces, cities and autonomous regions in the big plate of financial expenditure has only slightly increased or even decreased. The more obvious consequence is that there are signs of loss of personnel in the disease control system.

4. in the face of the sudden disturbance of the epidemic, it is necessary for the fiscal policy to respond actively in the short term. Suggestions: first, from the point of view of stabilizing the economy, the deficit ratio can exceed 3% in 2020. At the same time, we should adjust the expenditure structure, reduce conference expenses, travel expenses, and expenses for going abroad, and use expenditure-saving means to balance fiscal revenue and expenditure. Second, arrange special funds to increase investment in health and epidemic prevention. Third, tax and fee reduction. Tax relief for catering, transportation, tourism, accommodation and other industries seriously affected by the epidemic, and reduction of some government funds; donations to enterprises, individuals and other social forces are allowed to be fully deducted before the payment of income tax.

5. In addition to short-term coping, it may be more important to improve the long-distance running mechanism. Suggestions: first, the orientation of fiscal policy should be further shifted from economic policy to public policy, and the tilt towards people's livelihood should be strengthened. Second, financial investment in the field of public health needs to form a fixed mechanism to prevent artificial adjustment; third, financial resources follow the population. The cities with more concentrated economy are more able to pay the cost of public health and epidemic prevention, and the cities with more concentrated population are under greater pressure of contagion, which also requires that the financial resources for public health and epidemic prevention should be appropriately concentrated to the cities. for the less developed areas, the underdeveloped areas are supported by the central transfer payment.

The phenomenon of "the god of wealth follows the god of plague" still exists.

Recently, I have had a lot of exchanges with medical workers. In addition to communicating the progress of novel coronavirus, I also talked about some cold topics behind the epidemic. Especially in the process of prevention and treatment of infectious diseases, there is a phenomenon that "the god of wealth follows the god of plague". The so-called "God of Wealth" is the investment related to the prevention and treatment of infectious diseases, while the legendary evil god who can spread pestilence refers to infectious diseases.

Judging from past experience, there is often such a phenomenon that when a more serious infectious disease occurs or a period of time later, with the attention of the government and the public to the epidemic situation of infectious diseases, the relevant investment will increase significantly. For example, the relevant data of SARS in 2003 are also more supportive. for four consecutive years after the end of SARS, the growth rate of public financial expenditure on health care has shown extremely obvious signs of high growth. it shows obvious signs that "the god of wealth follows the god of plague".

Figure 1 will the growth rate of expenditure on disease prevention and control increase

But it is worth noting that the "god of plague" is often a sprint, while the "god of wealth" needs a long-distance race.

Major outbreaks often occur only once for a long time, and the duration of each outbreak is not very long. For example, in this novel coronavirus epidemic, with the gradual rise in temperature in the future, it is an inevitable trend for the epidemic to subside. Another example is the emergence of SARS in 2003, which lasted about 5-6 months, while reviewing the modern history of China, including the plague in Northeast China in 1910 (about half a year), the eradication of plague, smallpox and cholera in the early days of the founding of the people's Republic of China, and the outbreak of hepatitis An in Shanghai at the end of 1980 (about 3 months), the time is not long, but the impact is extremely serious.

This requires that after the sprint of the "god of plague", the "god of wealth" must run a long distance.

Observing the public financial investment in health care since 2003, it has been able to maintain a rapid growth in the four years after SARS, but especially since 2011, for the public financial expenditure of disease prevention and control institutions in medical and health care, the growth rate has become the norm. This may lead to imperfect funding guarantee mechanisms in some areas, and a long-term and stable investment guarantee mechanism for the prevention and treatment of infectious diseases has not yet been fully established, affecting the sustainable development of prevention and control work, and in the next "plague" sprint, and face tremendous pressure.

Personally, the reason why it is difficult for the "God of Wealth" to run a long distance is that the main goal of the government's work is still economic growth, and a large amount of fiscal expenditure is still tilting towards economic growth, while financial investment in the prevention and control of infectious diseases has no effect in the short term, it is more like a kind of "pure input", and it only works at a critical moment. For a period of time after the outbreak, the investment intensity may be maintained under the attention of governments at all levels, but with the extension of time, whether the "God of Wealth" can persist in long-distance running has become a question.

In the era of stock economy, the difficulty of the long-distance running of "God of Wealth" increases rather than decreases.

Since 2010, China's economy has gradually entered the stock era, and the rate of economic growth is declining. with the introduction of measures such as "business reform and increase" and tax reduction and fee reduction, the growth rate of public revenue has also declined accordingly. In other words, the amount allocated to the government is reduced among the three departments of the government, enterprises and residents. At the same time, the pace of marketization in the medical and health field is relatively slow, which leads to the main body of investment is borne by the government. The decline in the growth rate of public revenue will inevitably make it more difficult for the medical and health sector to "divide the cake".

Chart 2 year-on-year growth rate of public revenue and GDP current price in the current quarter

If the perspective sinks further to the place and intercepts three time periods (the end of SARS in 2004, December 2010, December 2019), there are very obvious signs that local public financial revenue has declined significantly compared with the previous period, and some provinces, cities and autonomous regions have also shown negative growth, which poses a difficult problem for the prevention and treatment of infectious diseases: can the investment in public health be maintained while the income decelerates?

Figure 3 the growth rate of local public financial revenue in 2019 is lower than that in the previous period.

The local fiscal expenditure at the same level, including disease prevention and control institutions, major public health projects, emergency handling of public health emergencies, emergency treatment, and sub-items related to infectious diseases, are included in the "public health" category in Medical and Health and Family Planning.

Among the 16 provinces, cities and regions with data, by the end of 2018, the proportion of public health expenditure in local fiscal expenditure in 15 provinces, cities and regions except Guangxi Autonomous region increased or decreased slightly compared with 2012. It is particularly noteworthy that in Gansu, Shaanxi, Inner Mongolia and other places, the original base of public health expenditure is relatively low, and the proportion of public health expenditure in the whole plate of financial expenditure has also declined.

Figure 4 the proportion of public health expenditure in a considerable number of provinces, cities and autonomous regions has slightly increased or decreased.

One of the more obvious consequences is the loss of personnel in the disease control system. According to the National Health Commission, by the end of 2018, there were about 188000 health workers in the centers for disease prevention and control in 31 provinces, cities and autonomous regions, more than 18000 fewer than at the end of 2005. There was a net decrease in 17 provinces and municipalities. For example, in Hubei Province, where the COVID-19 epidemic broke out, the number of health workers decreased by 8% compared with 2005, while the number of health workers in Shandong, Anhui, Hebei and other populous provinces all fell by more than 20%, and Shanxi was nearly 40%.

Chart 5 increase or decrease of health personnel in provincial, municipal and regional centers for disease prevention and control (2005-2018)

Only by ensuring the long-distance running of the God of Wealth can we deal with the sprint of the God of plague.

According to data from the Ministry of Finance, as of 5: 00 p.m. on January 29, finance at all levels had allocated a total of 27.3 billion yuan in subsidies for epidemic prevention and control to ensure the need for funds for epidemic prevention and control.

In the face of the sudden disturbance of the epidemic, it is necessary for the fiscal policy to respond actively in the short term.

First, the deficit ratio exceeded 3%.From the perspective of stabilizing the economy, fiscal policy in 2020 needs to be more active, and it is suggested that the deficit ratio can exceed 3%. At the same time, we should adjust the expenditure structure, reduce conference expenses, travel expenses, and expenses for going abroad, and use expenditure-saving means to balance fiscal revenue and expenditure.

Second, arrange special fundsTo increase investment in health and epidemic prevention for the purchase of hardware and equipment such as medical protection, diagnosis, treatment, patient transportation and so on. We will increase subsidies for front-line medical personnel and epidemic prevention workers, and exempt subsidies from personal income tax.

Third, tax reduction and reduction. Tax relief for catering, transportation, tourism, accommodation and other industries seriously affected by the epidemic, and reduction of some government funds; donations to enterprises, individuals and other social forces are allowed to be fully deducted before the payment of income tax.

In addition to short-term response, it may be more important to improve the long-distance running mechanism of the God of Wealth:

First, the orientation of fiscal policy should be further shifted from economic policy to public policy.

"Public policy" means that fiscal policy should not be limited to economic growth, but should gradually increase its tilt towards people's livelihood. According to the development practice of China's reform and opening up in the past 40 years, there was debt growth before 2007, that is, with the help of population dividend, foreign capital was introduced substantially and large-scale investment was made, but there was too little investment in education, health care, pension and other social welfare. to form a huge deficit. Incidents such as the "illegal production of vaccines" and the postponement of the payment of pensions in Heilongjiang have already reflected the obvious shortcomings of social undertakings, which need to provide financial protection, and should be used in the field of people's livelihood to increase investment in medical care and social security.

Second, financial investment in the field of public health needs to form a fixed mechanism.

The particularity of public health and epidemic prevention lies in that "we do not fight in peacetime, but we must always be prepared for war." once problems arise, they cannot be solved by non-governmental organizations and organizations, and must be led, organized and coordinated by the government. This requires increasing financial investment at all levels in the field of public health and epidemic prevention, studying and solving the problem of the proportion of public health expenditure in financial expenditure, increasing the proportion of public health expenditure in epidemic prevention expenditure, and, more importantly, forming a fixed mechanism. prevent artificial adjustment.

Third, financial resources follow the population.

At the present stage, both economy and population show a relatively obvious trend of "centripetal concentration", which means that, on the one hand, the more concentrated the economy is, the more able to pay the cost of public health and epidemic prevention; on the other hand, the more concentrated the population is, the greater the pressure on the infectious epidemic is, which also requires that the financial support for public health and epidemic prevention should be appropriately concentrated to the city. For the underdeveloped areas, the central transfer payment is used to support the bottom.