Objective: This study aims to construct a four-dimensional framework encompassing policy unification, fund security, system synergy, and governance transformation, to systematically elucidate the core essence, pathways, and impacts of provincial pooling in basic medical insurance. Method: Through comparative analysis of policy texts and cases from multiple provinces, we conducted an in-depth analysis of the implementation paths and effectiveness of provincial-level coordination. Results: Provincial pooling is a system reconstruction based on the pillars of unified policy, fund adjustment system, budget management, and operational services, following a gradual path of fund adjustment first, payment reform leading, data governance empowering, and hierarchical diagnosis and treatment collaboration. This measure significantly enhances institutional fairness and fund risk resistance, promotes coordinated development and regulation of medical insurance, medical services, and pharmaceuticals and modernization of governance, However, it is also necessary to guard against potential risks such as the exacerbation of resource siphoning. Conclusion: The key to successful reform lies in simultaneously deepening system collaboration, consolidating the grassroots service network, and completing a comprehensive transition of the governance system. In the future, it should deepen towards unified pooling and allocation, strengthen data-driven governance, and build a solid foundation for the universal medical insurance system.
Key words
provincial coordination /
coordinated development and regulation of medical insurance /
medical services /
and pharmaceuticals /
fund adjustment /
unified pooling and allocation /
basic medical insurance
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