This study draws on embedding theory and incentive mechanism theory to construct a multi-dimensional framework for analyzing the integration of county-level health insurance into primary healthcare.Using Qianjiang District,Chongqing,as a case study,it analyses how horizontally bundled funding and service transformation embed insurance into local health governance.The study finds that health insurance is embedded into primary governance through a systemic process driven by values,shaped by social structures,and supported by institutions,involving the reconfiguration of resources,relationships,and interests.Establishing primary care groups as budget units improves alignment between payment and service needs;linking budget limits,surplus incentives,and performance feedback strengthens provider motivation;and coordinated inter-agency mechanisms facilitate integration of fund management and service delivery.

This study draws on embedding theory and incentive mechanism theory to construct a multi-dimensional framework for analyzing the integration of county-level health insurance into primary healthcare.Using Qianjiang District,Chongqing,as a case study,it analyses how horizontally bundled funding and service transformation embed insurance into local health governance.The study finds that health insurance is embedded into primary governance through a systemic process driven by values,shaped by social structures,and supported by institutions,involving the reconfiguration of resources,relationships,and interests.Establishing primary care groups as budget units improves alignment between payment and service needs;linking budget limits,surplus incentives,and performance feedback strengthens provider motivation;and coordinated inter-agency mechanisms facilitate integration of fund management and service delivery.