The Dilemma and Breakthrough of Medical Insurance Collection for Urban and Rural Residents under Tax Collection

The report of the 20th National Congress of the Communist Party of China (CPC) clearly stated that "improve the basic endowment insurance and basic medical insurance systems", emphasizing "improving the multi-level social security system covering the whole people, coordinating urban and rural areas, fairness, unity, safety and sustainability". After the reform of state institutions in 2018, the responsibility for the collection and payment of social insurance premiums was transferred to the tax department, and the medical insurance collection model for urban and rural residents underwent a fundamental change. As an important part of China's medical security system, medical insurance for urban and rural residents has played an important role in reducing the medical burden of residents and promoting health equity, and is also an important part of the strategy of realizing a healthy China. However, with the rise of medical insurance costs year by year, the grassroots collection work is facing many difficulties, especially after the tax department takes over the collection function, the "last mile" problem of policy implementation is becoming more and more prominent, many residents choose not to pay medical insurance fees or only participate in insurance for the elderly in their families due to economic pressure or insufficient understanding of the policy, resulting in fluctuations in the insurance rate, low collection efficiency, and the sustainability of the medical insurance fund is threatened. The purpose of this paper is to deeply analyze the dilemma of urban and rural medical insurance collection under the tax collection model, and put forward a systematic way to break the situation.