A Review of the New Rural Cooperative Medical Scheme Under the

Background of Urban and Rural Medical Insurance Integration

Qingchuan Xu

School of Government Administration, Shenzhen University, Shenzhen, Guangdong, 518060, China

Keywords: New Rural Cooperative Medical Scheme, Integration of Medical Insurance, Health Equity.

Abstract: TAs the core system of China’s rural medical security system, the New Rural Co-operative Medical Scheme

has acted significantly in narrowing the urban-rural medical gap. With the ongoing unification of healthcare

coverage for urban and rural populations gaining momentum, contradictions such as regional imbalance and

reverse redistribution have gradually become prominent. This analysis collated the relevant literatures and

summarized the existing research on the practice of the NCMS from multiple dimensions. The research finds

that through practice and integration into medical insurance, although the NCMS has effectively improved

the supply of medical services through various means, there are still fundamental contradictions of regional

differences and group differences. The research conclusion indicates that future reforms need to be fairness

oriented. Only by establishing a differentiated mechanism and a better collaborative network can more

effective support be provided for the improvement of medical insurance efficiency.

1 INTRODUCTION

The policy of the New Rural Cooperative Medical

Scheme (hereinafter referred to as ‘the NCMS’)

originated from the social development problems in

China in the 1980s. With the disintegration of the

traditional rural health care system, a series of social

problems, such as farmers’ medical difficulties and

the disparity of healthcare resources between urban

and rural places, have become increasingly serious. In

2003, the General Office of the State Council of the

People’s Republic of China forwarded ‘the Opinions

on Establishing New Rural Cooperative Medical

Scheme’ (Guobanfa [2003] No. 3), launching the

national pilot of the NCMS (General Office of the

State Council of China, 2003). By 2010, the NCMS

had basically improved coverage in rural areas across

the country, with a participation rate of up to 95%.

However, the numerous differences in medical

resources between urban and rural zones remain a

major concern (Office of the People’s Government of

Lanzhou City, 2011; State Council of China, 2016).

As China continues to promote modernization and

development, more and more attention has begun to

focus on the deficiencies of the health care system for

achieving universal medical insurance and promoting

social equity. In 2016, the State Council of China

announced ‘the Opinions on integrating the Basic

Medical Insurance System for Urban and Rural

Residents (Guofa [2016] No. 3), marking the launch

of the health care integration (State Council of China,

2016). Medical insurance integration refers to the

integration of the Urban and Rural Resident Basic

Medical Insurance (hereinafter referred to as ‘the

URRBMI’) with the Urban Resident Basic Medical

Insurance (hereinafter referred to as ‘the URBMI’)

and the NCMS. It is also one of the core issues of

China’s medical security system reform in recent

years (see Table 1).

Against the backdrop of health coverage merger

policy implementation, the NCMS faces various

challenges, such as regional development imbalance,

reverse redistribution effect and other practical

problems. It is necessary to optimize the system effect

through more refined policy design, which provides

space for discussion and analysis in this explore.

The core goal of the URRBMI is to eliminate

urban and rural differences through system

integration. Practical measures include unified

financing mechanism, unified reimbursement

catalog, unified fund management and analysis and

treatment support. In particular, the objective calls for

government financial subsidies to rise concurrently

and for urban and rural populations to pay according

the same levels, integrate the original drug and

Xu, Q.

A Review of the New Rural Cooperative Medical Scheme Under the Background of Urban and Rural Medical Insurance Integration.

DOI: 10.5220/0014391500004859

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 1st International Conference on Politics, Law, and Social Science (ICPLSS 2025), pages 583-592

ISBN: 978-989-758-785-6

583

Table 1. The Construction Process of Primary Medical Insurance.

Yea

Polic

and practice Sta

e of developmen

2002

The CPC Central Committee and the State

Council of China announced ‘the Decision on

Further Strengthening Rural Health Work’,

suggesting the creation of a new health program

for rural places

The framework of the NCMS was clarified at

the national level for the first time

2003

The General Office of the State Council forwarded

‘the Opinions on Establishing the NCMS’ and

launched a nationwide pilot program

The programmatic document had emerged that

marked the transition from theory to practice of

the NCMS, and began to build a rural medical

securit

stem coverin

the whole countr

2007

The pilot program of the URBMI was launched,

covering non-employed urban residents

For the first time, a medical insurance system

was established for non-employee groups in

urban areas, forming an urban-rural division

with the NCMS.

2010 The NCMS had basically realized nationwide rural coverage, with a participation rate of over 95%.

2008-

2013

Eight provinces have taken the lead in piloting the integration

2013

The State Council of China issued ‘the Opinions

on Integrating the Basic Medical Insurance

stem for Urban and Rural Residents’

As an authoritative policy document, it clarifies

the relevant practical principles

2016

The health insurance programs of both rural and

urban residents have been integrated in 31

provinces across the country, and the National

Medical Insurance Administration is in charge of

unified mana

ement.

Achieved complete system, management, and

service unification and worked to end the dual

division among urban and rural zones.

service catalog in the URBMI and the NCMS. Then,

by utilizing different payout percentages to alleviate

the issue of resource crowding out of large hospitals,

the provincial level will coordinate the medical

insurance funds of suburban as well as rural medical

funds, increasing the amount that rural residents can

be reimbursed. This will improve the efficiency of

fund use and encourage patients to seek appropriate

medical care.

The policy design reflects the transition logic from

formal integration to substantive fairness. In reality,

however, the NCMS’s unity has regional economic

level disparities, primarily in vast agricultural regions,

local fiscal capacity and uneven management

efficiency, resulting in significant spatial

differentiation in the integration effect.

This article systematically reviewed the existing

literatures on the current status of the NCMS,

examines how health equity in the combining program

of medical insurance for rural and urban dwellers

affect the allocation of medical resources and financial

burden, while proposing the contributions and

shortcomings of existing exploration. It is hoped that,

based on the existing exploration, the findings can

provide policymakers with operational suggestions

such as regional differentiated adjustments and a

dynamic monitoring mechanism design.

2 ANALYZE METHODS AND

PROCESS

Literature searched for this exploration comes from

CNKI and Web of Science.

The keywords for searching in CNKI was ‘the

New Rural Cooperative Medical Scheme’/‘the

NCMS’, and specific screening was performed

through the search commands ‘Academic Journals’,

‘Peking University Core’/‘CSSCI’, and the literature

in the past five years/the top ten most cited literature.

A total of 69 studies were screened in the first

screening. In the second screening, literature that was

not related to the analysis topic (like emphasizing the

NCMS’s influence on consumption/pension/job

choice/fertility intention, etc.) was screened, and a

total of 32 literatures remained. The third screening

screened literatures that were related to the analysis

topic but had too narrow a focus and were not

valuable in the analysis of this explore or had

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different analysis perspectives from this explore

(such as limited to a single disease: heart disease,

gastric cancer, cardiovascular and cerebrovascular

diseases, etc., a single group: lonely elderly people,

left-behind children, etc., a single region: the specific

situation of a certain district in a certain city or a

certain county, etc.), and finally 14 literatures were

left as references for this explore (see Table 2).

In addition, the keyword ‘the Urban and Rural

Residents Basic Medical Insurance (the URRBMI)’

was included, and the search instructions were

‘Academic Journals’, ‘Peking University

Core’/‘CSSCI’, documents from the past five years,

and the top 20 most cited documents. Among the

basic 11 documents, after screening out documents

that were not related to the analysis topic of this

exploration, a total of 4 documents remained (see

Table 2).

Table 2. Illustration of CNKI Literature Search.

Keywords Steps Instructions

The number of

remaining

documents

Notes

The NCMS/ the New

Rural Cooperative

Medical Scheme

Primary

screening

Academic journals, Peking

University core/CSSCI, top 10 most

cited in the

ast 5

ears

Secondary

screening

Exclude literatures irrelevant to the

topic (such as consumption, elderly

care, fertility and other fields with

weak correlation

)

Elimination of

37 articles

Tertiary

screening

Exclude literatures with too narrow a

perspective (such as single disease,

rou

, or re

ional ex

lores, etc.

)

Elimination of

18 articles

13 articles in total

The Urban and Rural

Residents Basic Medical

Insurance/the URRBMI

Primary

screening

Academic journals, Peking

University core/CSSCI, top 20 most

cited in the past 5 years

Secondary

screening

Exclude literatures irrelevant to the

topic

Elimination of

7 articles

4 articles in total

17 articles in total

Table 3. Illustration of Web of Science Literature Search.

Keywords Steps Instructions

The number of

remaining

documents

Notes

The New Rural

Cooperative Medical

Scheme/the

NCMS

Primary

Screenin

Article, Top 20 in the past 5

ears/Hi

Cite

140

Secondary

Screenin

Exclude non-Q1 partition and

low-im

act-factor literatures

Elimination of

104 articles

Tertiary

Screening

Exclude low-relevance

literatures (such as labor supply,

single population/disease

explores, etc.)

Elimination of

24 articles

12 articles in total

The Urban and Rural

Residents Basic Medical

Insurance/the URRBMI

Primary

Screening

Article、Q1、Top 20 in the past

5 years/Highly Cite

Secondary

Screening

Exclude literatures irrelevant to

the topic

Elimination of

13 articles

3 articles in total

15 articles in total

A Review of the New Rural Cooperative Medical Scheme Under the Background of Urban and Rural Medical Insurance Integration

585

The keywords for the search in Web of Science

were ‘the New Rural Cooperative Medical

Scheme’/‘the NCMS’, and the search instructions

were ‘Article’, the literature in the past five years/the

top 20 most cited literatures. The first screening

resulted in a total of 140 literature. In the second

screening, the literature that was not in the Q1

partition and had a relatively small impact factor was

screened, and a total of 36 articles remained. The third

screening screened various types of literature that

were less relevant to the analysis topic of this explore

and had different perspectives (such as the impact of

labor supply, a single social group, the treatment of a

single disease, the impact of population mobility,

etc.), and finally a total of 12 literatures remained (see

Table 3).

In addition, the keywords was included: ‘the Urban

and Rural Residents Basic Medical Insurance’/‘the

URRBMI’, and the search instructions were ‘Article’,

Q1 partition, literatures in the past five years, and the

top 20 most cited literatures. Among the basic 16

literatures, after screening out investigate questions

that were not related to the analysis topic of this

exploration, a total of 3 literatures remained.

Finally, a total of 33 documents were found by

combining the literatures searched by CNKI and Web

of Science (see Table 3).

3 LITERATURE REVIEW

3.1 Literature Induction Logic

Based on an extensive review of literatures, an

inductive structure is established as shown in the table

4, using a systematic overall framework to analyze

the progressive inductive logic from institutional

input to policy processing, then to effect output, and

finally focusing on feedback regulation (see Table 4).

Table 4: Literature summary structure.

Structural level Core conten

Institutional input

level

The necessity, path, and results of combining health insurance in agricultural

ions as well as urban zones

Challenges and coping strategies of regional heterogeneity to policy

implementation

Policy processing

level

Policy design optimization (such as tiered mechanism reform, payment method

innovation)

Supporting mechanism innovation (fund coordination, information platform

construction, etc.)

Effect output level

Health performance and economic performance

Povert

reduction results and income distribution effects

Feedback adjustment

level

Re-examination of group heterogeneity and regional heterogeneity

3.2 System Input Level

3.2.1 Urban-Rural Medical Insurance

Pooling and System Integration

The necessity, progression, and evaluation of the

melding of both metropolitan and rural medical

coverage systems are the main topics of this section.

It highlights the importance of unified finance

standards, reimbursement ratios, and other methods

in reducing the disparity between urban and rural

areas. In this part, some literatures explore that in the

process of integrating the NCMS with the URBMI,

the rate at which rural populations use medical

services has considerably increased by unifying

financing standards, reimbursement ratios and

medical catalogs.

Some scholars have found in their explorations

that from 2008 to 2018, the NCMS significantly

increased the hospitalization rate of rural residents;

and after the integration of medical insurance in areas

where the NCMS was implemented, the

hospitalization reimbursement rate and

reimbursement ratio were also significantly improved

(Yan et al, 2022; Huang & Wu, 2020). The

integration of medical insurance based on the NCMS

has effectively targeted the situation of poverty

generated by illness and has significantly reduced the

incidence of poverty caused by illness among rural

residents by 6.57%. In addition, the targeting effect is

more obvious for groups with poor health, chronic

diseases, low-to-medium consumption, and high

medical expenses (Li et al.,2021).

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The disparity in poverty between urban and rural

regions must still be reduced, nevertheless, by

medical insurance integration using strategies like

uniform finance standards and broadened

reimbursement scope, because the economic factor is

still the key hindering the realization of fairness (Ren

et al, 2022). At the same time, regional heterogeneity

has also affected the specific results. For instance,

compared to eastern China, the degree of

improvement in health levels in central and western

China is far greater (Meng et al, 2024). To avoid

compromising the true impact of medical insurance

integration, the NCMS should keep concentrating on

the predicament of families with limited assets having

to pay for the medical treatment of wealthier areas

because of an unequal distribution of resources (Peng

& Yue et al, 2020).

Through empirical analysis, Qiu et al. discovered

that the degree of economic growth must be the basis

for integrating medical insurance in urban as well as

rural regions. Taking Dongguan, Taicang and other

relatively economically developed regions in China

as examples, in addition to lowering the proportion of

individual expenses for rural people, the integration

model can raise the outpatient benefit rate and

standardize financing criteria and benefits. They

pointed out that the integration needs to be promoted

in stages: developed regions can promote the

integration in one step, and underdeveloped regions

should adopt a layered integration approach to

balance fiscal pressure and insurance demand.

Although the integration has alleviated the imbalance

of health care resources, a more notable rise has been

caused by geographical heterogeneity in

hospitalization utilization in the western region in

China, and we need to be vigilant about reverse

subsidy issues, such as the urban-rural cost gap. Qiu

et al. emphasized fair financing and equal benefits in

the integration practice, and suggested reducing the

cost of institutional separation through unified

management and information platforms (Qiu et al,

2011). Other scholars also pointed out that in addition

to platform unification and phased promotion,

institutional integration should shift from payment for

services to payment for disease type, prepayment of

total amount or per capita payment to control

excessive medical treatment, and alleviate financing

fairness through payment by income tiers (Liu &

Vortherms, 2017; Luo et al, 2021).

3.2.2 Addressing Regional Heterogeneity

Some scholars focus on the differences in policy

effects between regions in China. From the practice

of the NCMS to its integration, they propose a

discussion on how to deal with the uneven regional

resource distribution and structural differences in the

degree of benefit.

In the practice of the NCMS, regional

heterogeneity has long been reflected. The NCMS’s

major disease insurance has decreased the frequency

of poverty vulnerability in the center and western

family units in China despite the health care system’s

influence on poverty reduction is more noticeable in

the central and westernmost fields, as was previously

indicated, and the degree of advantage is much

greater than it is in the eastern zone (Gao & Ding,

2021). In such economically underdeveloped regions,

although the policy tilt effect is more obvious, due to

the absolute disadvantages in per capita income and

medical service utilization, the potential migration of

medical resources from countryside to metropolitan

regions (also known as the reverse subsidy dilemma)

presents a problem for medical fairness in central and

western agricultural regions (Ren et al, 2022; Peng &

Yue, 2020).

Taking the study of Gao & Ding as an example, the

empirical results show that in the western and central

portions of the state, the NCMS’s major disease

insurance has a much deeper effect on poverty

reduction than in the eastern area. Additionally, the

central and western areas have seen a greater decline

in the incidence of poverty vulnerability, but the

eastern region has seen a somewhat limited effect.

This difference is due to the weak economic

foundation and medical resource scarcity in the

western and central areas, and the higher marginal

utility brought by policy bias (Gao & Ding, 2021).

Some academics stress that actively expanding health

care coverage, reducing economic inequities, and

optimizing regional resource allocation are necessary

to address regional heterogeneity and attain the full

inclusivity of medical cover system (Ren et al, 2022;

Meng, 2024).

3.3 Policy Operation and Processing

Level

3.3.1 Policy Design Optimization

This subsection mainly refers to the investigative

perspective that focuses on the defects of medical

insurance, such as the tiering mechanism and the

adverse selection while proposing optimization and

reform suggestions. From this perspective, it is

mainly reflected in the further expansion and

improvement based on the practical results of the

NCMS.

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587

The deviations in informal systems and

understandings of insured persons, such as

interpersonal relationships and information quality,

have led to problems such as insufficient transparency

of medical insurance policies and adverse distribution

(Office of the People’s Government of Lanzhou City,

2011; Yuan et al, 2020; Xiong, 2022). Based on the

empirical analysis of the NCMS, Yip & Hsiao

concluded that the previous approach disregards

outpatient costs for chronic diseases and was overly

preoccupied with hospitalization prevention,

resulting in limited poverty reduction effects.

Through the comparison of the experimental rural

mutual medical care model (RMHC), they confirmed

that the strategy of covering outpatient services,

canceling deductibles and integrating funding pools

can reduce the poverty gap by 17%-18.5%,

significantly reducing the risk of medical poverty.

Yip Winnie also advocated the abolition of the

Medical Savings Accounts (MSA) and the transfer of

resources to outpatient and chronic disease

protection, emphasizing that policy design needs to

adapt to the epidemiological characteristics of the

disease burden (Yip & Hsiao, 2009).

3.3.2 Innovation of Supporting Mechanisms

As scholar Yu reported, from 2003 to 2010, the

NCMS rapidly increased the participation rate and the

utilization rate of inpatient services for rural residents

by implementing a strategy of low payment

thresholds and high fiscal subsidies, but there are still

fundamental problems such as low welfare levels,

adverse distribution, and regional imbalances.

Through analysis, Yu suggested that a dynamic

adjustment mechanism and differentiated subsidies

linked to farmers’ income should be established, and

that the reform and optimization of mechanisms,

including cross-departmental collaboration of fund

advances, risk warning mechanisms, and insurance

incentives for welfare supplements, should be

promoted (Yu, 2015). At the same time, according to

the decline in individual disease prevention rates

generated by the increase in insurance participation

rates, health risks can be classified and multi-level

insurance contracts can be designed to alleviate the

corresponding ex-ante moral risks (Guo & Zhou,

2021). Based on the practical measures of city

Beijing’s medical insurance, its system can be

actively refined and medical service needs can be met

by refining payment methods and establishing a

national unified data monitoring and dynamic

evaluation system (Liu & Vortherms, 2017).

In short, policy design needs to balance efficiency

and fairness, and adapt to disease burden and group

needs through benefit measures such as weakening

individual power differences and promoting

coordination and integration (Zhai, 2021).

3.4 Effect Output Level

3.4.1 Health Performance and Economic

Performance

This component focuses on assessing the primary

consequences of the NCMS on medical resource

consumption (hospitalization rate, total cost) and

health level (expressed health, mental health, and

objective health), while paying attention to changes

in economic burden.

Based on the national health service survey data

from 2003 to 2013, according to Zhang et al., the

NCMS considerably raised rural residents’ inpatient

service usage rates (from 2.7% to 7.7%) and

eliminated the urban-rural income gap in service

utilization, but the risk of catastrophic medical

expenditures for low-income groups still remained

high (for example, in 2013, the proportion of medical

expenditures of the lowest-income households

exceeding 40% reached 24.7%, while that of the

highest-income households was only 2.5%). Even

though middle-class and upper-class families now

bear less medical expense, the contradiction between

health needs and the payment ability of low-income

groups has intensified, and the economic risks have

not been effectively alleviated. They emphasized that

although the NCMS has implemented remarkable

results in health equity, financial protection for low-

income families still needs to be strengthened (Zhang

et al, 2021).

During the healthcare system integration phase,

empirical studies reveal that unifying urban-rural

medical coverage effectively improves beneficiaries’

self-assessed wellness, psychological conditions, and

clinical health indicators, while simultaneously

narrowing urban-rural health outcome gaps and

mitigating disparities across socioeconomic groups

(Zheng et al, 2021).

In terms of economic performance, out-of-pocket

medical expenses fell from 60 percent in 2001 to 35

percent in 2011, raising per capita income of farmers

participating in the NCMS by about 4 percent. The

rate of medical service usage, overall medical care,

and out-of-pocket medical costs all rise with the

incorporation of medical insurance (Yu, 2015; Qi,

2011; Ma & Li, 2021). Although the integration of

health care has improved health coverage, it has

exacerbated overall health inequalities, which tend to

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588

increase over time (He & Shen, 2021).

Cheng & Zhang pointed out that, taking the elderly

as an example, the NCMS has raised the rate of

medical care usage and considerably improved the

health of those who are insured by reducing the

phenomenon of abandoning medical care due to

poverty. However, actual medical expenditures have

not decreased significantly and the incidence of major

disease expenditures has not improved either. The

demand for medical services is relatively elastic,

resulting in price subsidies stimulating consumer

demand, offsetting the cost control effect, and limited

economic performance. The compensation

mechanism needs to be optimized to balance health

improvement and economic burden (Cheng & Zhang,

2012).

In summary, although the practice and integration

of the NCMS have accomplished remarkable results

in improving health, the insurance mechanism needs

to be further optimized to alleviate the outpatient

burden of insured farmers and to realize the

effectiveness of medical insurance through policy

publicity and resource coordination (Bei et al, 2024;

Zhang et al, 2024).

3.4.2 Poverty Reduction and Income

Distribution Effects

The NCMS’s regulatory implications for poverty

rates, catastrophic medical costs, economic

disparities, and the likelihood of unequal distribution

are made clear.

Qi systematically evaluated the poverty reduction

and income distribution effects of the NCMS based

on micro panel data from 30 provinces and regions

across the country from 2003 to 2006. His analysis

found that the NCMS significantly reduced the

probability of poverty at the farmer level and

contributed favorably to the decrease of poverty. By

reducing the economic disparity inside the village, the

NCMS simultaneously decreased the hamlet’s Gini

coefficient by 6.4%; nevertheless, this had no obvious

impact on the province’s overall income distribution.

Agriculturalists with low and intermediate earnings

are the primary beneficiaries of the NCMS’s income-

increasing effect, and they need to count on the

external economic climate for assistance, while high-

income farmers have limited benefits. This shows that

although the NCMS has effectively alleviated local

poverty and inequality within the village, higher-level

income distribution regulation still needs institutional

optimization and coordinated policy support (Qi,

2011).

Income redistribution is harmed by the basic

medical insurance system, even while medical

coverage helps to bridge the income gap caused by

growing medical expenditures. Additionally, rising

medical costs reduce the real impact of poverty

reduction. The effect varies from system to system

(Liao & Yu, 2021; Li et al, 2020).

In addition to the effectiveness of the NCMS, the

problem of reverse distribution among different

income groups is particularly prominent. For

instance, high-income groups benefit more from the

NCMS’s ability to reduce poverty, the introduction of

critical sickness insurance indirectly widens the

income gap, and the likelihood of catastrophic

medical expenses is negatively correlated with group

income (Luo & Yan, 2022; Zhao, 2021). In addition,

the program offers those with limited incomes only a

restricted degree of economic protection. In 2013,

China’s National Health Service Survey indicated

that 24.7% of the lowest-income families had medical

costs that accounted for more than 40% of their

income (while the highest-income families only had

2.5%) (Zhang et al, 2021). From this perspective, the

academic community is concerned that although the

NCMS has alleviated some poverty, the overall

catastrophic expenditure has not been improved well,

and it is necessary to balance the fairness of

distribution by strengthening the monitoring of

medical insurance integration, optimizing the

reimbursement ratio, improving the financing

mechanism and improving the level of protection for

low-income groups (Liu & Vortherms, 2017; Wang

et al, 2020; Jin et al, 2020).

3.5 Feedback Adjustment Level

Mainly includes analyzing the differentiated impact

of policies on urban and rural areas, income, age,

health behavior and other groups, highlighting the

problem of unequal benefits for vulnerable groups.

The policy effect of the NCMS also needs to focus

on the challenges of resource allocation and benefit

fairness. Since the high-income group’s poverty

vulnerability is effectively reduced while the low-

income group’s poverty is not, income stratification

has made the poverty reduction effect more

pronounced in this group. Beyond that, the earnings

growth of the wealthy individual class was much

more than that of those with reduced incomes (this is

referred to as the economically disadvantaged class

only rises by 5%, while the high-income group

increases by 10-15%) (Luo & Yan, 2022; Zhao,

2021). At the same time, differences in gender,

chronic diseases, age and other aspects also lead to

different poverty reduction effects, and the elderly

A Review of the New Rural Cooperative Medical Scheme Under the Background of Urban and Rural Medical Insurance Integration

589

group has a higher hospitalization rate, and the

outpatient rate of male insured persons is significantly

higher than that of female insured persons (Luo et al,

2021; Ding et al, 2023).

Taking Peng & Yue’s analysis as an example, they

focus on the group differences and structural equity

in the integration of the NCMS. Its primary

conclusion is that because of the significant

difference in the cost and use rate of inpatient

treatments throughout urban and agricultural areas,

there is a chance that reverse subsidies from rural to

urban medical insurance funds will occur after

medical insurance unification. Similarly, inequalities

in the risk-sharing system are exacerbated by the

differences in income and medical resources between

villages and towns. Therefore, they pointed out that

the integration of medical insurance must be careful,

by strengthening the system design and rural health

construction to promote the effectiveness of

integration (Peng & Yue, 2020).

To put it briefly, because of the regional and group

variations in the medical insurance system, distinct

security measures must be incorporated into the

policy design for various groups in order to integrate

the NCMS into medical security and further

encourage integration, such as vulnerable groups and

low-income groups, to accomplish the overall

equality of medical services (Huang & Wu, 2020;

Zhang et al, 2021; Zheng et al, 2021; Ma & Li, 2021).

4 MAIN CONTRIBUTIONS AND

DEFICIENCIES OF EXISTING

EXPLORES

4.1 Contributions

Existing exploration in the field of practice and

integration of the NCMS mainly reflects the

following important contributions:

Research confirms the beneficial effects of the

NCMS on rural inhabitants’ health and services,

while confirming that medical insurance integration

has effectively narrowed the urban-rural health

inequality. In addition, some explores have

accomplished the visualization of policy effects in the

population and spatial dimensions by constructing

policy transmission paths and analysis models. At the

level of constructing integration theory, some

literatures innovatively proposed different gradual

reform paths, systematically demonstrated the core

mechanisms such as the unification of the overall

coordination mechanism and the standardization of

management services, and provided theoretical

support for practical operations.

4.2 Limitations and Shortcomings

Although the existing investigations have made

significant progress, there are still the following

limitations and deficiencies:

The existing investigations appear insufficient on

regional links. Existing results mostly adopt the

macro-division method of the east, middle and west,

or analyze and investigate specific concentrated

areas, lack of systematic analysis on the adaptability

of policy tools to realize links between different

regions, and less attention to national-level plans and

actions to achieve transition based on distinct

principles.

Enhancement of the strategy’s outcome evaluation

mechanism is expected. Most explores are limited to

cross-sectional data analysis, and the long-term

effects of the integration of the NCMS are not tracked

enough. A standardized indicator system has not yet

been formed in terms of fund sustainability

assessment and service quality monitoring.

There is a gap in the analysis on micro-

mechanisms. Although existing literatures focus on

theoretical propositions of moral hazard, such as

induced medical demand, empirical investigations on

the behavioral decision-making patterns of insured

subjects and their policy awareness is still weak.

4.3 Explore Prospects

In view of some of the shortcomings shown in the

analysis, future investigations can pay additional

attention to the following aspects:

Quantitative investigation on regional

heterogeneity. In the view of the practical problem of

regional resource allocation differences as mentioned

above, the exploration should be based on the

traditional division of east, middle and west, and

explore a regional classification system that is more

in line with the needs of medical insurance policies.

That is, pay more attention to core indicators such as

economic level (per capita disposable

income/financial self-sufficiency rate), medical

resource density (number of beds per thousand

people/primary hospital coverage rate) and

population structure (aging rate/proportion of floating

population) at the county level, realize the spatial

division formulated according to different demand

levels to provide more accurate analysis for

differentiated compensation policies.

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Focus on cross-domain policy transmission

exploration. Exploration should pay more attention to

the balance of policy effects among regions. The

lagging of medical insurance policies in some regions

is not entirely due to financial capacity, but also

includes policy cognition gaps and administrative

coordination costs. The primary role of non-economic

issues in the progressive merger route and the health

care insurance system’s operation must be actively

investigated, and solutions and analysis must be

offered to make collaborative management a reality.

5 CONCLUSION

The relationship between integration and the

NCMS’s practical impact may be summed up as

follows, based on the aforementioned literature

overview, system integration analysis, and policy

impacts analysis:

The system integration reform focuses on overall

coordination and regional dynamic optimization,

which has significantly improved the health

performance and poverty reduction effects, but there

are conflicts in the reverse distribution of policy

effects and regional resource allocation differences,

that is, the overall efficiency and fairness

measurement problem.

The overall optimization design of the policy has

improved the overall situation in each region to a

certain extent, but the group differences within each

region, urban-rural differences, and differences in

resource allocation between regions are difficult to

effectively solve in a short period of time.

The accuracy of the medical insurance system

(involving various groups) and the reimbursement

mechanism must be considered in the real

optimization of the aforementioned issues; the

balance of policy effects between the east and the

west in regional coordination management; and to

discover benefit measures to deal with adverse

selection and social capital dependence.

In summary, institutional integration has driven

the optimization of policy effects through unified

standards, regional inclination, and dynamic

optimization, but its design flaws, such as insufficient

inclusiveness and low transparency, have generated

an imbalance in the distribution of health and

economic benefits. Future reforms need to be guided

by fairness while realizing two-way optimization of

institutional integration and policy effects through

precision, regional coordination, and transparency

measures.

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