中国当前正在进行的城乡居民基本医疗保险制度整合，即整合城镇居民基本医疗保险与新型农村合作医疗，是推进共享发展的重大举措。本书基于实际调研和公开数据研究了涉及这一制度整合的一系列问题，包括制度整合的基础与紧迫性、影响不同地区制度整合进展差异的因素、不同地区制度整合的经验与模式，以及部分地区的“三保合一”探索。有下列主要结论：

制度整合的基础与紧迫性。从全国层面看，中国当前正处于城镇化的关键时期，城乡居民基本医疗保险制度整合是城镇化进程的一部分。城镇居民医保与新农合的筹资都由财政主导，构成制度整合的基础。城镇化进程中的大规模人口流动、财政主导城镇居民医保新农合筹资、医疗服务中固有的信息不对称，三因素结合，导致了城乡居民基本医疗保险的软预算约束问题，如重复参保、福利竞赛等。软预算约束和其他多种因素共同作用，使城镇居民医保、新农合基金压力问题逐渐浮现，当前城乡居民基本医疗保险制度整合有紧迫性。

影响制度整合进展的因素：（1）各地城镇化水平不一，城镇居民医保新农合基金压力有异，城乡居民基本医疗保险制度整合的压力动力也就不同。最早一批实现制度整合的，都是市场化程度、城镇化水平高且城乡一体化的地区。医保/新农合基金压力大的地区也更倾向于整合制度。（2）城镇居民医保、新农合由不同行政部门主管，在管理经办体制、基金统筹层次、实际筹资、实际待遇等方面有差异。而且，各地差异程度也不相同。从实际进展看，因为“指标效应”（对其他地区的示范意义），越是重要的特大城市，管理体制造成的整合障碍越大。

不同地区制度整合的经验与模式。以地级市为基本考量单位，有几点经验：（1）管理与经办体制。大部分地区选择整合到人社部门进行管理，而整合到卫生部门有两种情况：城镇人口较少、经济较不发达的郊县，以及农村参保人群有特殊特征的地市。财政体制（如“省管县”）、地级市所辖县级区域平均人口等是影响基金统筹层次选择的重要因素。（2）筹资与待遇。当城镇居民医保、新农合的筹资待遇水平差距较大时，实行两档或多档是可行选择；但档次选择同时受到当地财力、县级区域人口占全市比重等因素影响。（3）制度整合阶段可能带来财政负担增加。除了筹资中名义财政补贴的增加之外，还包括财政兜底支出的增加，以及相关的信息化建设等。特别是兜底支出，从各地实践来看，整合带来的需求释放往往难以准确测算，可能带来财政负担的大规模增加。（4）制度上进行市级统筹的地区仍可以通过基金分级管理来实现基金的县级统筹。不过分级管理基础上的调剂金制度，其效果或许并不比直接统收统支要好，因为地方可能通过减小结余的努力来侵占调剂金部分，而政府作为统收统支管理者的角色在理论上要比各县支出协调者的作用有效。（5）地方在实际操作中，选择了不同的整合路径，各有利弊。

部分地区已实现“三保合一”。在一些城镇化水平较高、城乡一体化地区，“三保合一”已实现，即将城镇居民医保、新农合与城镇职工医保统一为一项基本医保制度。最早一批完成城乡居民基本医疗保险制度整合的地区位于广东、浙江、江苏等地，如广东东莞、中山、佛山，浙江嘉兴，江苏常熟等。这些地区一般是首先建立城镇职工医保（与全国一致），然后在国家试点推广新农合的背景下，建立新农合。但此后往往不会单独建立城镇居民医保，而是直接将其余无保险群体纳入原新农合，建立城乡统一的基本医疗保险，并进一步推动与城镇职工医保整合实现“三保合一”。以东莞为代表的“三保合一”的整合路径是，首先对所有居民提供一项统一的基本医保，统一缴费和待遇水平，然后在该基本医保之上提供补充医保，且只有参加了统一的基本医保才能参加补充医保。

基于本书的研究，我们提出下列政策建议：（1）明确城乡居民基本医疗保险“保基本”的定位；（2）对整合阶段的财政投入增加应有充分预期；（3）整合后的医保应当在调解医疗资源配置中发挥更积极的作用；（4）将“三保合一”作为重要的改革方向。

The integration of the basic medical insurance system for urban and rural residents that China is currently undertaking, that is, the integration of basic medical insurance for urban residents and the new rural cooperative medical care, is a major measure to promote shared development. Based on actual research and open data, this book studies a series of issues related to this institutional integration, including the foundation and urgency of institutional integration, the factors affecting the differences in the progress of institutional integration in different regions, the experience and models of institutional integration in different regions, and the exploration of "three guarantees in one" in some regions. The following main conclusions are made: the basis and urgency of institutional integration. From the national level, China is currently in a critical period of urbanization, and the integration of the basic medical insurance system for urban and rural residents is part of the urbanization process. The financing of urban residents' medical insurance and the new rural cooperative are led by finance, which forms the basis for institutional integration. The combination of large-scale population movement in the process of urbanization, finance-led financing of urban residents' medical insurance and new rural cooperative financing, and inherent information asymmetry in medical services have led to the soft budget constraints of basic medical insurance for urban and rural residents, such as duplicate participation and welfare competitions. Soft budget constraints and other factors work together to make the pressure of urban residents' medical insurance and the new agricultural cooperative fund gradually emerge, and the current integration of the basic medical insurance system for urban and rural residents is urgent. Factors affecting the progress of system integration: (1) The level of urbanization varies from place to place, the pressure of the new agricultural cooperative fund for urban residents' medical insurance is different, and the pressure motivation for the integration of the basic medical insurance system for urban and rural residents is also different. The first batch of areas to achieve institutional integration are all areas with a high degree of marketization, high urbanization level and urban-rural integration. Regions under high pressure from Medicare/IFCD are also more inclined to integrate systems. (2) Urban residents' medical insurance and new rural cooperative are under the supervision of different administrative departments, and there are differences in management and handling systems, fund coordination levels, actual financing, actual treatment, etc. Moreover, the degree of variation varies from place to place. In terms of actual progress, the more important megacities are, the greater the obstacles to integration caused by the management system because of the "indicator effect" (exemplary significance for other regions). Experience and models of institutional integration in different regions. Taking prefecture-level cities as the basic consideration units, there are several points of experience: (1) management and handling system. Most regions choose to integrate into the human resources and social security sector for management, while integration into the health sector has two situations: suburban counties with small urban populations and less developed economies, and prefectures and cities with special characteristics of rural insured people. The financial system (such as "provincial-administered counties") and the average population of county-level regions under the jurisdiction of prefecture-level cities are important factors affecting the choice of the overall level of the fund. (2) Financing and treatment. When there is a large gap between the financing treatment level of urban residents' medical insurance and the new rural cooperative cooperation, it is feasible to implement two or more levels; However, the choice of grade is also affected by factors such as local financial resources and the proportion of the population of county-level regions in the city. (3) The stage of institutional integration may bring about an increase in fiscal burden. In addition to the increase in nominal financial subsidies in financing, it also includes the increase in fiscal expenditure, as well as related information construction. Especially for bottom expenditure, from the perspective of local practice, the release of demand brought about by integration is often difficult to accurately measure, which may bring about a large-scale increase in financial burden. (4) Districts with city-level coordination can still realize the county-level overall planning of funds through hierarchical management of funds. However, the transfer fund system based on hierarchical management may not be more effective than the direct unified revenue and expenditure, because the local government may encroach on the transfer fund through efforts to reduce the balance, and the government's role as the unified revenue and expenditure manager is theoretically more effective than the role of the expenditure coordinator of the counties. (5) In actual operation, local governments have chosen different integration paths, each with its own advantages and disadvantages. Some areas have achieved "three guarantees in one". In some areas with a high level of urbanization and urban-rural integration, the "three guarantees in one" has been realized, that is, the medical insurance for urban residents, the new rural cooperative and the medical insurance for urban employees have been unified into one basic medical insurance system. The first batch of areas to complete the integration of the basic medical insurance system for urban and rural residents are located in Guangdong, Zhejiang, Jiangsu and other places, such as Dongguan, Zhongshan, Foshan, Jiaxing, Zhejiang, Changshu, Jiangsu, etc. In these areas, urban workers' medical insurance is generally established first (consistent with the whole country), and then in the context of the national pilot promotion of new agricultural cooperation, the new agricultural cooperative is established. However, after that, it is often not necessary to establish urban residents' medical insurance alone, but directly to include the rest of the uninsured groups in the original new rural cooperative to establish a unified basic medical insurance for urban and rural areas, and further promote the integration with urban workers' medical insurance to achieve "three guarantees in one". The integration path of the "three guarantees in one" represented by Dongguan is to first provide a unified basic medical insurance for all residents, unified payment and treatment levels, and then provide supplementary medical insurance on top of the basic medical insurance, and only those who participate in the unified basic medical insurance can participate in the supplementary medical insurance. Based on the research in this book, we put forward the following policy recommendations: (1) clarify the positioning of basic medical insurance for urban and rural residents as "basic insurance"; (2) There should be sufficient expectations for the increase in financial investment in the integration phase; (3) The integrated medical insurance should play a more active role in mediating the allocation of medical resources; (4) Take "three guarantees into one" as an important reform direction.（AI翻译）