Research on provincial-level medical insurance coordination in Guangxi’s multi-ethnic regions from the perspective of urban–rural integration

Objective 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. Methods A comparative analysis approach was employed to examine the “unified revenue and expenditure” model and the “adjustment fund” 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. Results In 2023, the accumulated balance of Guangxi’s 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 months for employee insurance and 11.51 months for resident insurance. Cross-regional medical treatments reached 5.888 million visits, costing 19.165 billion yuan, leading to a “siphoning effect” (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. Conclusion 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.