The Dilemma of Medical Insurance under Commissioning Agency:The Impact of Provincial-level Pooling on Fund Income and Expenditure——Take Urban Employee Basic Medical Insurance as an Example
China's urban employee basic medical insurance system is constrained by a low level of coordination,thus the system faces challenges in achieving more extensive risk-sharing.This study utilizes eight provinces that have implemented provincial-lev-el pooling as case studies to investigate the impact of provincial-level pooling on the fund income and expenditure.The key find-ings are as follows:Firstly,the provincial-level pooling of urban employee basic medical insurance results in a 10.4％decrease in per capita fund income,with no significant impact on per capita fund expenditure.Secondly,when different provincial pooling models are examined and compared to the absence of provincial pooling,the provincial fiscal adjustment model leads to a 9.8％reduction in per capita fund income,with no significant impact on per capita fund expenditure.In contrast,the provincially pooled revenue and expenditure model leads to an 11.5％reduction in per capita fund income and an 18.6％increase in per capita fund expenditure.Thirdly,it is observed that when the actual contribution rate falls below the policy-mandated rate and implementation of tax department collection and the system's aging level is greater than or equal to 28.07％,the provincially pooled revenue and expenditure model significantly lowers per capita fund income while raising per capita fund expenditure.The result remains stable after making a robustness test with counterfactual test,change of appraisal method and narrowing-down of samples.Fourthly,the implementation of provincial fiscal adjustment and provincial pooled revenue and expenditure systems respectively increase the o-verall financial responsibility by 14％and 68.75％.In conclusion,this paper puts forward the recommendations such as the intro-duction of a complementary reward and incentive mechanism,the achievement of vertically managed healthcare institutions,and the adoption of a progressive reform pathway.
urban employee basic medical insuranceprovincial-level poolingfund incomefund expenditurepanel data
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万方数据
