Abstract

Under the idea of fairness and sharing, medical insurance integration will be the focus of the development of China’s medical insurance system in the new period. Medical insurance integration is the corresponding reform and adjustment under the guidance of the fairness and sustainable development of national social security. Currently, there are several local pilots and policy experimentations about the integration of urban and rural medical insurance system. In order to ensure such integration policies are scientific and rational, both academic and practical circles should rethink theira chievements and deficiencies and put forward rationalization proposals. In this book, the author tries, starting with its fragmentation, to rethink the integration policies for their improvement. By adopting the literature analysis method, comparative approaches and the normative research combined with the empirical research, there is a deep analysis about the key subjects from the dual perspectives of both theory and practice.

Firstly, around the theme of“Medical Insurance Fragmentation”and“Medical Insurance Integration”, this book makes a comprehensive and systematic explanation of the concept and connotation. By comparing the medical insurance system in different country, we find that the“Medical Insurance Fragmentation”can be divided into two types—the fragmentation with the fair results and the fragmentation with the unfair results, according to whether the result is fair or not. In China, the fragmentation with the unfair results is the main object of“Medical Insurance Integration”. Samely, according to whether the result is fair or not, the“Medical Insurance Integration”also can be divided into the two types—formal integration and substantive integration. Under the national conditions of China, the“Differential Unity Mode”may be the best choice.

Secondly, there is a comprehensive and systematic definition on medical equity by focusing on the insurance mechanism, financing mechanism, as well as the payment mechanism. Meanwhile, this part clarifies the operational judging criteria about medical equity.

Thirdly, the writer intends to come up with the concept of“Stratum Fragmentation”and“Regional Fragmentation”innovatively. The book also explains the phenomenon and essence of the concepts. Furthermore, this book puts forward the policy objectives of“de-Stratum”and“de-Regional”integrations which should be achieved by the integration of medical insurance and be regarded as the standard for measuring the medical insurance integration policy. In addition, the article points out that the fragmentation in the family is the microscopic embodiment of“Medical Insurance Fragmentation”. So, the“de-Fragmentation”based on the family unit will be the logical starting of the integration. Medical Insurance Integration should begin with the integration of the family.

Next, the book reexamines the local pilots of the medical insurance integration. Based on the typological division about integration scheme of local pilots, the book makes a comparative research among the four main integration schemes. Then it comes to a conclusion that there exists a hidden peril of“Refragmentation”in some pilots. The flexible insurance mechanism based on the paying capacity and the“Multiple levels in a single medical insurance system”is the main factors leading to“Refragmentation”. They also lead directly to the correlation between income level and security level.

In the fifth place, there is an international comparison on the theme of medical insurance integration. The book makes a deep research on the relatively mature medical insurance systems in several East Asian countries and regions. The study shows that, in China, the integration of urban and rural medical insur-ance mainly pays more attention to breaking the household registration barriers and the identity ones in the insurance mechanism, while both the financing mechanism and the payment mechanism are still fragmented in many areas. The regressive nature under the quota payment and the differential treatments among groups of different incomes affect the fairness of China's medical insurance system seriously. Then they make the system fragmented much more.

After the five pieces of viewpoint mentioned above, the author reflects on the medical insurance integration. It does not simply mean cutting out the components of system. The unified system is not the best choice for our country. At present, the“Differential Unity Mode”should be abetter alternative, a system which is non-unified in form but unified in essence.

In the last, aparting from the political meaning and returning to the institutional rationality, family integration should have the implications beyond the urban and rural integration. As the basic social unit, the“de-Fragmentation”based on the family unit will be the logical starting of the integration. So, different from the urban and rural integration, the book also proposes a new system conception innovatively. It is“Family-Unit-Based Insurance”that establishes the family as the basic unit for medical insurance enrollment. Then, Urban Resident Basic Medical Insurance should be merged with Urban Employee Basic Medical Insurance through this initiative. Also, the Urban Family Medical Insurance will be built up. Differing from the individual enrollment, the family unit as basis of enrollment should be adopted whether in city or in countryside. The New Rural Cooperative Medical Insurance, while keeping the traditional family-orientated insurance enrollment method, should gradually change into the Rural Family Medical Insurance. Before China achieves a high level of urbanization, these two systems—the Urban Family Medical Insurance and the Rural Family Medical Insurance—will be parallel for a long term. Dualistic structure does not mean dualistic fragmentation. As to China's medical insurance integration policy, a better choice is the“Differential Unity Mode”—a mode which is non-unified in form but unified in essence. It includes the equal insurance mechanism which breaks the identity barriers. Then, floating population can choose freely the insured platform according to their domicile. Besides, the mode also includes the Ability-to-Pay Principle in financing mechanism and unified payment mechanism which means equal treatments to all insured nationals by institutional innovations and financial subsidies.

Keywords: Medical Insurance Fragmentation；Medical Insurance Integration；Stratum Fragmentation；Region Fragmentation；Refragmentation；Family-Unit-Based Insurance；The Ability-to-Pay Principle；The Differential Unity Mode