{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T07:05:19Z","timestamp":1779433519612,"version":"3.53.1"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aims to explore the necessity, model selection, and implementation suggestions for the provincial-level overall planning of basic medical insurance in Guangxi, China, to address the structural imbalance of medical insurance funds and improve the sustainability of the system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A comparative analysis approach was employed to examine the \u201cunified revenue and expenditure\u201d model and the \u201cadjustment fund\u201d model for provincial-level overall planning. Data were collected from official sources, including the 2023 Statistical Communique on the Development of Medical Security in Guangxi and policy documents. The analysis focused on fund balance, demographic structure, and regional disparities in Guangxi.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In 2023, the accumulated balance of Guangxi\u2019s employee medical insurance pooling fund reached 37.736 billion yuan, and the resident medical insurance fund balance was 43.197 billion yuan. However, significant regional imbalances existed, with the number of months covered by the accumulated balance being 22.40\u202fmonths for employee insurance and 11.51\u202fmonths for resident insurance. Cross-regional medical treatments reached 5.888 million visits, costing 19.165 billion yuan, leading to a \u201csiphoning effect\u201d (i.e., the excessive concentration of patients and funds towards medical resource-rich areas) that exacerbated regional disparities. The adjustment fund model is recommended as an initial step for Guangxi, given its flexibility and lower reform resistance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Promoting provincial-level overall planning of basic medical insurance in Guangxi is essential to solve fund imbalances and improve sustainability. The adjustment fund model serves as a transitional approach, with gradual movement toward unified revenue and expenditure. Key suggestions include establishing dual-track adjustment funds, scientific fund extraction rules, and enhancing digital infrastructure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1796550","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T06:11:04Z","timestamp":1779430264000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Research on provincial-level medical insurance coordination in Guangxi\u2019s multi-ethnic regions from the perspective of urban\u2013rural integration"],"prefix":"10.3389","volume":"14","author":[{"given":"Yang","family":"Zhao","sequence":"first","affiliation":[{"name":"School of Humanities and Management, Guilin Medical University","place":["Guilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongji","family":"Qin","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine, Guilin Medical University","place":["Guilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tingting","family":"Li","sequence":"additional","affiliation":[{"name":"School of Public Health, Guilin Medical University","place":["Guilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Jiang","sequence":"additional","affiliation":[{"name":"School of Humanities and Management, Guilin Medical University","place":["Guilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuangling","family":"Qin","sequence":"additional","affiliation":[{"name":"School of Marxism, Guilin Medical University","place":["Guilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1186\/s12939-019-1088-x","article-title":"Pooling arrangements in health financing systems: a proposed classification","volume":"18","author":"Mathauer","year":"2019","journal-title":"Int J Equity Health"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e0003651","DOI":"10.1371\/journal.pgph.0003651","article-title":"Moving toward universal health coverage with a national health insurance program: a scoping review and narrative synthesis of experiences in eleven low- and lower-middle income countries","volume":"5","author":"Flourence","year":"2025","journal-title":"PLOS Global Public Health"},{"key":"ref3","volume-title":"A Study on the Control of Medical Expenses in the New Rural Cooperative Medical Scheme [D]","author":"Chuangzhou","year":"2011"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1186\/s12939-023-01927-1","article-title":"The promotion of pooling level of basic medical insurance and participants' health: impact effects and mediating mechanisms","volume":"22","author":"Dong","year":"2023","journal-title":"Int J Equity Health"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1129","DOI":"10.1186\/s12889-024-18623-2","article-title":"Enhancing pooling levels strengthens the risk resilience of healthcare insurance: empirical evidence from Gansu, China","volume":"24","author":"Hu","year":"2024","journal-title":"BMC Public Health"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1186\/1475-9276-13-17","article-title":"The inequity of the Swiss health care system financing from a federal state perspective","volume":"13","author":"Salari","year":"2014","journal-title":"Int J Equity Health"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1186\/s12913-025-12946-9","article-title":"Medical insurance integration and spatial effects in China: evidence from quasi-natural experiments and linked administrative data","volume":"25","author":"Yan","year":"2025","journal-title":"BMC Health Serv Res"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1826","DOI":"10.1186\/s12889-025-23027-1","article-title":"Does the trans-provincial immediate reimbursement reduce health gap between urban and rural floating population? 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