Empirical Study on the Calculation Scheme for Global Budget of Health Insurance in Tightly Integrated County Medical Communities Based on International Experiences
Li Xiang
Zhang Chunfeng
Li Ling
Abstract：Objective:To develop an operational global-budget estimation framework for tightly County Medical Communities(CMCs)that balances equity and incentives.Methods:The budget-setting practices was reviewed to promote a two-step framework combining non-negotiable factors and negotiable factors.Using medical insurance settlement and statistical data,rolling forecasts,and compare errors against benchmark models were conducted.Results:In most years,the fitting error at Tightly Integrated County CMC level stays within 5%.Conclusion:A tiered calculation and decision-making framework incorporating non-negotiable factors,negotiable factors,and annual rolling adjustments should be adopted to advance the refined regional total budget reforms.This framework will enhance the linkage between healthcare institutions'quality performance and surplus incentives,driving a coordinated shift in payment methods from a"cost-control-oriented"approach to a"cost control+quality improvement"model.
Keywords：tightly integrated county medical communitymedical insurance fundglobal budgetinternational experience
Publication Date：2026-02-05
Online Publishing Date：2026-03-16(First online date of this platform, not the publication date of the document)
Pages：7( 19-25 )