目的: 从理论层面分析城乡居民主动参保行为影响机理与激活路径,提出激活城乡居民主动参保行为的驱动策略。方法: 聚焦现阶段我国部分地区出现的城乡居民基本医疗保险漏保现象,实地走访调研江苏、浙江、山西等地,与医保经办机构负责人、村委会主任和普通居民等进行半结构式访谈;围绕政策情境、效用体验和居民行为等方面,构建城乡居民主动参保行为理论分析框架。结果: 居民主动参保行为受政策情境及其体验效用交互影响,需在既定政策情境下激活居民主动参保行为,需进一步关注居民主动参保行为演化特征,实现居民主动参保行为持续和获益。结论: 建议进一步优化基本公共服务,促进城乡居民基本医疗保障的公平性,强化城乡居民对基本医保的效用体验,驱动城乡居民主动参保。

Objective: The paper attempts to analyze the mechanism and activation path of active participation behavior of urban and rural residents from a theoretical perspective, and propose driving strategies for activating participation behavior of urban and rural residents. Methods: Focusing on the phenomenon of urban and rural residents choosing not to participate in basic medical insurance in some regions, field visits were conducted in Jiangsu, Zhejiang and Shanxi Province, and semi-structured interviews were conducted with the heads of medical insurance claim management and fund administration agencies, village committee directors, and ordinary residents. We constructed a theoretical analysis framework for the active participation behavior of urban and rural residents in basic medical insurance, which was based on policy context, effectiveness and experience, and residents' behavior. Results: The active participation behavior of residents in insurance is influenced by the interaction between policy context and its experience and effectiveness. It is necessary to activate the active participation behavior of residents in the established policy context, and further attention should be paid to the evolutionary characteristics of active participation behavior of residents to achieve continuous and beneficial participation behavior. Conclusion: It is suggested to further optimize basic medical insurance public services, promote the fairness of basic medical insurance security for urban and rural residents, strengthen the effectiveness and experience of basic medical insurance for urban and rural residents, and drive urban and rural residents to actively participate in basic medical insurance.