目的: 作为多层次医疗保障的关键补充,城市定制型商业医疗保险（普惠保）参保率持续低迷,呈现“供给热、消费冷”的反差。本研究旨在拆解不同人群的参保决策差异,揭示覆盖不足与健康体流失的微观成因,为提升参保率提供证据。方法: 以安德森模型与助推理论构建分析框架,采用质性研究,对山东省四地市21位分属“从未参保”“持续参保”“中断参保”特征的居民进行深度访谈,提炼决策差异主题。结果: 三类群体参保逻辑显著分化。从未参保者因低估风险且对产品缺乏了解而未投保;持续参保者出于风险规避、行业信任及社会责任动机而续保;中断参保者因理赔体验不佳与负面口碑扩散而退出。结论: 普惠保应从泛化宣传转向精准助推,依据人群信息与信任缺口配置差异化策略,以实现覆盖面扩大与制度可持续的平衡。
Abstract
Objective: As a key supplement to a multi-tier healthcare security system, city-customized commercial health insurance has persistently low enrollment, revealing a supply-demand paradox of enthusiastic provision but lukewarm uptake. This study dissects heterogeneity in enrollment decisions across population groups and identifies micro-level causes of inadequate coverage and the loss of healthier enrollees from the risk pool, providing evidence to increase participation. Methods: Using the Andersen model and nudge theory as the analytic framework, we conducted a qualitative study with in-depth interviews of 21 residents from four prefecture-level cities in Shandong Province, representing never-enrolled, continuously-enrolled, and discontinued-enrollment profiles. We identified themes that captured differences in enrollment decisions. Results: The three groups exhibited markedly divergent decision rationales. Never-enrolled individuals refrained from enrolling because they underestimated risk and lacked product knowledge; continuously-enrolled individuals renewed coverage, driven by risk aversion, trust in the industry, and a sense of social responsibility; discontinued enrollees withdrew because of unsatisfactory claim experience and the spread of negative word-of-mouth. Conclusions: UCCMI should shift from generic mass publicity to precise nudges, deploying differentiated strategies that address group-specific information and trust gaps to balance expanded coverage with system sustainability.
关键词
普惠保 /
参保率 /
定性访谈 /
策略研究
Key words
city-customized commercial health insurance /
enrollment rate /
qualitative interviews /
strategy research
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