目的: 调查徐州市城乡居民基本医疗保险参保居民持续参保必要性认知现状及其影响因素,为完善居民医保参保长效机制提供参考。方法: 采用多阶段分层随机整群抽样方法,抽取徐州市参加城乡居民基本医疗保险的居民进行问卷调查。运用描述性分析研究持续参保必要性认知,采用χ²检验进行单因素分析,建立决策树算法模型进行多因素分析。结果: 共调查城乡居民基本医疗保险参保居民624人,其中557人（89.3%）认为继续参加城乡居民基本医疗保险有必要,67人（10.7%）认为没有必要。单因素分析显示,性别、年龄、是否患有慢性病、是否参加商业保险、缴费金额满意度和报销金额满意度与持续参保必要性认知有关（P<0.05）。决策树模型分析显示,居民持续参保必要性认知影响因素的重要性从大到小依次为年龄、报销金额满意度、是否患有慢性病、缴费金额满意度、性别。结论: 徐州市城乡居民基本医疗保险参保居民对持续参保必要性的总体认知较高,但不同群体之间存在明显差异。应重点关注年轻、健康状况较好及制度获得感较弱的人群,通过优化政策宣传、完善缴费与待遇机制、增强制度获得感,提高城乡居民基本医疗保险参保稳定性。

Objective: The paper attempts to investigate the necessity awareness of continuous enrollment in Urban and Rural Residents’ Basic Medical Insurance (URRBMI) among insured residents in Xuzhou and to explore its influencing factors, so as to provide evidence for improving the long-term enrollment mechanism of URRBMI. Methods: A multistage stratified random cluster sampling method was used to select residents enrolled in URRBMI in Xuzhou for a questionnaire survey. Descriptive analysis was conducted to examine their necessity awareness of continuous enrollment. Chi-square tests were used for univariate analysis of the influencing factors, and a decision tree model was constructed for multivariate analysis. Results: A total of 624 residents enrolled in URRBMI were surveyed, among whom 557 (89.3%) considered it necessary to continue participating in URRBMI, while 67 (10.7%) considered it unnecessary. Univariate analysis showed that gender, age, presence of chronic disease, participation in commercial insurance, satisfaction with the contribution amount, and satisfaction with the reimbursement amount were associated with the necessity awareness of continuous enrollment (P < 0.05). Decision tree analysis indicated that the influencing factors, in descending order of importance, were age, satisfaction with the reimbursement amount, presence of chronic disease, satisfaction with the contribution amount, and gender. Conclusions: Insured residents enrolled in URRBMI in Xuzhou generally demonstrated a high level of necessity awareness for continuous enrollment, although marked differences were observed across population groups. Greater attention should be paid to younger individuals, those in relatively good health, and those with a weaker sense of institutional benefit. Efforts should focus on optimizing policy publicity, improving contribution and benefit mechanisms, and enhancing residents’ perceived benefit from the system, so as to strengthen enrollment stability in URRBMI.