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The integration of the basic medical insurance system for urban and rural residents that China is currently undertaking, that is, the integration of basic medical insurance for urban residents and the new rural cooperative medical care, is a major measure to promote shared development. Based on actual research and open data, this book studies a series of issues related to this institutional integration, including the foundation and urgency of institutional integration, the factors affecting the differences in the progress of institutional integration in different regions, the experience and models of institutional integration in different regions, and the exploration of "three guarantees in one" in some regions. The following main conclusions are made: the basis and urgency of institutional integration. From the national level, China is currently in a critical period of urbanization, and the integration of the basic medical insurance system for urban and rural residents is part of the urbanization process. The financing of urban residents' medical insurance and the new rural cooperative are led by finance, which forms the basis for institutional integration. The combination of large-scale population movement in the process of urbanization, finance-led financing of urban residents' medical insurance and new rural cooperative financing, and inherent information asymmetry in medical services have led to the soft budget constraints of basic medical insurance for urban and rural residents, such as duplicate participation and welfare competitions. Soft budget constraints and other factors work together to make the pressure of urban residents' medical insurance and the new agricultural cooperative fund gradually emerge, and the current integration of the basic medical insurance system for urban and rural residents is urgent. Factors affecting the progress of system integration: (1) The level of urbanization varies from place to place, the pressure of the new agricultural cooperative fund for urban residents' medical insurance is different, and the pressure motivation for the integration of the basic medical insurance system for urban and rural residents is also different. The first batch of areas to achieve institutional integration are all areas with a high degree of marketization, high urbanization level and urban-rural integration. Regions under high pressure from Medicare/IFCD are also more inclined to integrate systems. (2) Urban residents' medical insurance and new rural cooperative are under the supervision of different administrative departments, and there are differences in management and handling systems, fund coordination levels, actual financing, actual treatment, etc. Moreover, the degree of variation varies from place to place. In terms of actual progress, the more important megacities are, the greater the obstacles to integration caused by the management system because of the "indicator effect" (exemplary significance for other regions). Experience and models of institutional integration in different regions. Taking prefecture-level cities as the basic consideration units, there are several points of experience: (1) management and handling system. Most regions choose to integrate into the human resources and social security sector for management, while integration into the health sector has two situations: suburban counties with small urban populations and less developed economies, and prefectures and cities with special characteristics of rural insured people. The financial system (such as "provincial-administered counties") and the average population of county-level regions under the jurisdiction of prefecture-level cities are important factors affecting the choice of the overall level of the fund. (2) Financing and treatment. When there is a large gap between the financing treatment level of urban residents' medical insurance and the new rural cooperative cooperation, it is feasible to implement two or more levels; However, the choice of grade is also affected by factors such as local financial resources and the proportion of the population of county-level regions in the city. (3) The stage of institutional integration may bring about an increase in fiscal burden. In addition to the increase in nominal financial subsidies in financing, it also includes the increase in fiscal expenditure, as well as related information construction. Especially for bottom expenditure, from the perspective of local practice, the release of demand brought about by integration is often difficult to accurately measure, which may bring about a large-scale increase in financial burden. (4) Districts with city-level coordination can still realize the county-level overall planning of funds through hierarchical management of funds. However, the transfer fund system based on hierarchical management may not be more effective than the direct unified revenue and expenditure, because the local government may encroach on the transfer fund through efforts to reduce the balance, and the government's role as the unified revenue and expenditure manager is theoretically more effective than the role of the expenditure coordinator of the counties. (5) In actual operation, local governments have chosen different integration paths, each with its own advantages and disadvantages. Some areas have achieved "three guarantees in one". In some areas with a high level of urbanization and urban-rural integration, the "three guarantees in one" has been realized, that is, the medical insurance for urban residents, the new rural cooperative and the medical insurance for urban employees have been unified into one basic medical insurance system. The first batch of areas to complete the integration of the basic medical insurance system for urban and rural residents are located in Guangdong, Zhejiang, Jiangsu and other places, such as Dongguan, Zhongshan, Foshan, Jiaxing, Zhejiang, Changshu, Jiangsu, etc. In these areas, urban workers' medical insurance is generally established first (consistent with the whole country), and then in the context of the national pilot promotion of new agricultural cooperation, the new agricultural cooperative is established. However, after that, it is often not necessary to establish urban residents' medical insurance alone, but directly to include the rest of the uninsured groups in the original new rural cooperative to establish a unified basic medical insurance for urban and rural areas, and further promote the integration with urban workers' medical insurance to achieve "three guarantees in one". The integration path of the "three guarantees in one" represented by Dongguan is to first provide a unified basic medical insurance for all residents, unified payment and treatment levels, and then provide supplementary medical insurance on top of the basic medical insurance, and only those who participate in the unified basic medical insurance can participate in the supplementary medical insurance. Based on the research in this book, we put forward the following policy recommendations: (1) clarify the positioning of basic medical insurance for urban and rural residents as "basic insurance"; (2) There should be sufficient expectations for the increase in financial investment in the integration phase; (3) The integrated medical insurance should play a more active role in mediating the allocation of medical resources; (4) Take "three guarantees into one" as an important reform direction.(AI翻译)
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