《保险研究》20251008-《城乡居民连续参保决策行为研究——来自医保行政数据的微观证据》（朱凤梅、王震）

［摘   要］自愿参保原则下，提高城乡居民连续参保积极性，是实现全民参保，维持制度可持续发展的关键。本文基于某省2018~2023年基本医保参保信息库和患者就诊明细数据库，构建面板数据模型，从行为经济学视角研究城乡居民参加基本医保的连续性问题。研究发现，个体参保决策存在“锚定效应”，上期参过保的个体，当期选择继续参保的概率平均显著增加32.0个百分点。健康冲击和医保报销是影响个体连续参保的关键因素。如果参保人待遇期内遭受过健康冲击或得到过医保报销，其连续参保的概率会显著增加，健康冲击程度越大或医保报销水平越高，连续参保的概率越高。但不同疾病对个体连续参保的影响存在差异，肿瘤、心脏病、脑血管疾病患者连续参保的概率显著下降。异质性分析表明，年龄在18~44岁或60岁及以上、户口为城镇居民的个体连续参保概率更低。进一步分析发现，同龄人的相对健康风险对个体连续参保具有显著的正向影响，外来人口连续参保的概率更低。从政策导向看，决策部门需要根据个体参保行为和特征，有针对性地做好居民参保工作。

［关键词］居民医保；连续参保；行为决策；锚定效应

［基金项目］中国社会科学院“青启计划”项目“中国特色医保支付改革的政策效果：费用控制与资源配置”(2024QQJH100)；中国社会科学院学科建设“登峰战略”资助计划(DF2023YS24)。

［作者简介］朱凤梅，中国社会科学院工业经济研究所副研究员；王震，中国社会科学院经济研究所研究员、中国社会科学院大学经济学院教授。

A Study on Urban and Rural Residents’ Decision-making Behavior in Continuous Enrollment—Micro Evidences from Health Insurance Administrative Data

ZHU Feng-mei,WANG zhen

Abstract：Under the principle of voluntary enrollment,enhancing the willingness of urban and rural residents to continuously participate in the basic medical insurance is crucial for achieving universal coverage and maintaining the sustainable development of the system.This study utilizes the basic medical insurance enrollment database and patient medical record database of a province from 2018 to 2023 to construct a panel data model,examining the continuity of urban and rural residents’ participation in basic medical insurance from a behavioral economics perspective.The findings reveal an “anchoring effect” in individual enrollment decisions:individuals who were enrolled in the previous period are,on average,32.0 percentage points more likely to continue enrollment in the current period.Health shocks and medical insurance reimbursements are key factors influencing continuous enrollment.If enrollees experience health shocks or receive insurance reimbursements during the coverage period,their probability of continuous enrollment increases significantly.The greater the health shock or the higher the reimbursement level,the higher the likelihood of continuous enrollment.However,the impact of different diseases on continuous enrollment varies.Patients with tumors,heart disease,or cerebrovascular diseases show a significant decrease in the probability of continuous enrollment.Heterogeneity analysis indicates that individuals aged 18-44 or 60 and above,as well as those with urban household registration,have a lower probability of continuous enrollment.Further analysis shows that the relative health risks of peers have a significant positive impact on individual continuous enrollment,while migrant populations are less likely to enroll continuously.From a policy perspective,decision-making authorities need to tailor enrollment strategies based on individual enrollment behaviors and characteristics to effectively promote resident participation.

Key words：urban and rural residents’ medical insurance;continuous enrollment;behavioral decision-making;anchoring effect