目的: 分析制度问题感知对灵活就业人员基本医保参保意愿的影响,并考察医疗保险认知的解释作用。方法: 基于1876份灵活就业人员问卷数据,构建制度问题感知指数和医疗保险认知变量,采用Logit模型进行实证分析,并通过更换为Probit模型和调整核心解释变量测度方式进行稳健性检验。结果: 制度问题感知对灵活就业人员基本医保参保意愿具有显著正向影响,平均边际效应为11.26个百分点;制度问题感知对医疗保险认知具有显著正向影响;分维度结果显示,缴费负担、待遇预期、关系转接和信息获取感知均显著影响参保意愿。结论: 灵活就业人员基本医保参保意愿受到制度问题感知的影响。参保意愿与制度各环节密切相关,建议从缴费机制、待遇预期、转移接续和信息服务等方面优化制度安排,提升基本医保制度对灵活就业人员的适配性。

Objective: The paper attempts to analyze the impact of institutional problem perception on the willingness of flexible employment workers to enroll in basic medical insurance, and to examine the explanatory role of medical insurance cognition. Methods: Based on questionnaire data from 1876 flexible employment workers, an institutional problem perception index and a medical insurance cognition variable were constructed. A Logit model was used for empirical analysis, and robustness tests were conducted by switching to a Probit model and adjusting the measurement of the core explanatory variable. Results: Institutional problem perception had a significant positive impact on flexible employment workers’ willingness to enroll in basic medical insurance, with an average marginal effect of 11.26 percentage points. Institutional problem perception also had a significant positive impact on medical insurance cognition. Dimension-specific results showed that perceptions of contribution burden, expected benefits, portability of social insurance relations, and information access all significantly affected enrollment willingness. Conclusion: The willingness of flexible employment workers to enroll in basic medical insurance is affected by institutional problem perception, and medical insurance cognition also plays a certain explanatory role. Enrollment willingness is closely related to various institutional links. It is recommended to optimize institutional arrangements in terms of contribution mechanisms, benefit expectations, transfer and continuation, and information services, so as to improve the adaptability of the basic medical insurance system to flexible employment workers.