目的:城乡居民医保制度是减轻居民医疗负担、防范因病返贫致贫的关键民生保障制度。本研究旨在分析西部经济欠发达农村地区城乡居民医保持续参保的制约因素及助推策略,为健全基本医疗保险参保长效机制提供参考。方法:基于广西壮族自治区百色市三个行政村的实地调研,通过实地访谈农村居民、村干部、基层医保工作人员,构建从政策、机构、个人和环境层面分析的四维框架。结果:制约居民持续参保的因素主要是制度层面的部门协同不足与政策传导效果有待提升、服务层面的资源匮乏与基层医疗服务能力薄弱,以及个人层面的短视理性与生存压力下的支出排序。结论:建议强化风险意识教育、健全精准筹资机制、改善基层医疗服务供给、优化医保持续参保激励,系统提升居民持续参保意愿,助力城乡居民医保制度可持续发展。

Objective:The urban and rural residents' basic medical insurance system is a key livelihood security mechanism for alleviating residents' medical burden and preventing return to poverty due to illness. The paper attempts to analyze the constraining factors and explore boosting strategies for the continuous enrollment of urban and rural residents in basic medical insurance in economically underdeveloped rural areas of western China, so as to provide references for improving the long-term participation mechanisms of basic medical insurance. Method:This study was based on field research in three administrative villages of Baise City, Guangxi Zhuang Autonomous Region, which employed in-depth interviews with rural residents, village cadres, and grassroots healthcare security staff. A four-dimensional analytical framework was constructed from the perspectives of policy, institutional, individual, and environmental levels. Results:The main factors constraining residents' continuous enrollment in basic medical insurance include the inadequate departmental collaboration and policy transmission at the institutional level, the lack of resources and weak grassroots medical service capacity at the service level, and the individuals' short-term rationality and the spending priorities under the pressure of financial survival. Conclusion:Recommendations include strengthening risk awareness education, improving the targeted financing mechanism, enhancing the supply of grassroots medical services, and optimizing the incentives for continuous participation in medical insurance, so as to systematically enhance residents' willingness to remain continuously enrolled and contribute to the sustainable development of the urban and rural residents' medical insurance system.