Since 2012, Guangdong Province has implemented a policy of integrating basic medical insurance for urban and rural residents in accordance with the instructions of the State Council, which has effectively met the medical needs of urban and rural residents and promoted social stability. However, the balance of revenues and expenditures of the medical insurance fund is still a major challenge. This study takes the basic medical insurance fund for urban and rural residents in five cities in the mountainous region of northern Guangdong as the object of research, aiming to identify problems and propose countermeasures. Firstly, the health insurance system in the region is outlined, and then the 2015-2022 data and GM(1,1) model are used to predict the situation in the next 20 years. The projections show that the health insurance fund may be at financial risk due to slow growth in revenues, increasing expenditures, and a continuing decline in the insured population. The main reasons for this are the decrease in the number of insured people, the ageing population, the increasing financial pressure, and the rapid growth of expenditures. In response to these challenges, a series of solutions have been proposed: strengthening publicity to increase the participation rate, controlling expenditure growth to improve the settlement mechanism, strengthening supervision to combat insurance fraud, adopting diversified financing methods to increase the fund's value-added capacity, upgrading the level of health insurance co-ordination to establish a wider system of inter-region and inter-sectoral health insurance co-ordination, and strengthening health education to promote changes in the medical service model. The comprehensive implementation of these measures will not only effectively balance the income and expenditure of the health insurance fund, but also provide practical experience and reference for the reform of the health insurance system in other regions.

Jiazhen Mo, Xusheng Zhang. A Study on the Balance of Income and Expenditure in the Urban and Rural Residents' Medical Insurance Fund in the Northern Mountainous Region. Academic Journal of Humanities & Social Sciences (2024) Vol. 7, Issue 5: 123-137. https://doi.org/10.25236/AJHSS.2024.070520.

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