【摘要】 基于2015至2017年我国293个地级市的城乡居民基本医疗保险数据与应用双向固定效应模型，本文发现财政收入水平越高的地区，当地居民医保基金结余反而越少的现象，并进一步提出“制度约束-激励条件-路径依赖”的分析框架，通过8省18市的田野研究阐述了现象背后的作用机制，即在现有行政与医疗体制的约束下，地方财政部门在城乡居民医保基金的管理过程中会由于财政收入水平的高低而产生强度不同的兜底压力、大小不同的补偿资源分配空间以及软硬不同的预算约束，并导致路径依赖或强化或勉强维持的选择，最终呈现“越富越亏、越穷越省”这一预算承诺动态调整的结果。研究结果同时表明即使在基本公共服务领域，地方财政依然呈现典型的“以收定支”特征。更多还原

【Abstract】 This paper utilizes data from 293 Chinese prefectures spanning 2015-2017 and employs a two-way fixed-ef fects model to identify an inverse correlation between local government revenue and surpluses in urban and rural residents’ medical insurance funds. The study further elucidates the underlying mechanism for this phenomenon based on field research conducted in 18 cities across 8 provinces, utilizing the analytical framework of "institutional constraints-incentives-path dependence." Within the constraints of the prevailing administrative and healthcare system, local fiscal authorities with varying levels of fiscal revenues exhibit varying degrees of solvency, resource allocation capacity, and budget constraints. This dynamic process, combined with path dependence and reinforcement, leads to an adaptive pattern of budgetary commitments, where wealthier regions tend to spend while less a ffluent regions prioritize savings. Furthermore, the study unveils that even in the realm of basic public services, local finances manifest a distinct "revenue-dependent" characteristic.更多还原