Under the voluntary enrollment policy for basic medical insurance for urban and rural residents, motivating sustained proactive participation is crucial for the system’s sustainability. This study introduces the behavioral economics concept of “policy experience utility”, defining it as a four-dimensional comprehensive perception encompassing process, service, outcome, and emotional trust throughout the enrollment cycle. Based on field research and semi-structured interviews in regions such as Guizhou Province and Yunnan Province, and integrating the principles of “loss aversion” and “mental accounting” from prospect theory, this paper constructs an integrative analytical framework. This framework elucidates the internal logic of how policy design drives proactive enrollment behavior by systematically shaping residents’ positive experience utility, thereby influencing their risk perception and value judgment. On this basis, the study identifies multiple pathways—policy incentives, organizational coordination, stakeholder interaction, and norm shaping—to systematically optimize the policy experience of residents, ultimately aiming to establish a long-term driving mechanism characterized by precise targeting, multi-party collaboration, value perception reshaping, and health demand orientation.
Key words
policy experienced utility /
basicmedical insurance for urban and rural residents /
proactive enrollment /
driving mechanism
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] 国务院办公厅.关于健全基本医疗保险参保长效机制的指导意见:国办发〔2024〕38号[A/OL].(2024-07-26)[2025-12-25].https://www.nhsa.gov.cn/art/2024/8/1/art_104_13427.html.
[2] 李珍. 基本医疗保险参保机制改革的历史逻辑与实现路径[J].暨南学报(哲学社会科学版),2022,44(11):69-79.
[3] 郑功成,谭琳子.居民医保个人筹资政策:缘起、困境与优化[J].中国农村经济,2024(03):2-21.
[4] 叶静,唐贤兴.城乡居民医疗保险不参保行为的影响因素分析——基于逆向选择、医保筹资及报销水平的视角[J].岳麓公共治理,2024,3(04):68-80.
[5] 王昭茜. 城乡居民基本医疗保险中断参保的典型特征与治理路径——基于制度主义的分析视角[J].学习与实践,2025(01):95-107.
[6] 王永杰. 人力资本、公平感知与农村居民基本医疗保险参与——基于四川农村地区的实证分析[J].西北农林科技大学学报(社会科学版),2022,22(05):153-160.
[7] 徐富明,刘安宁.丹尼尔·卡尼曼的心理学思想和学术遗产[J].心理学探新,2025,45(02):99-106.
[8] 吴波,万宏.城乡居民医保整合对农村流动人口参保行为的影响研究[J/OL].西北人口,1-13[2025-11-02].https://link.cnki.net/urlid/62.1019.C.20250815.0949.002.
[9] 毕圣贤,陈迎春,李刚,等.城乡居民医保脱保问题与治理机制研究[J].卫生经济研究,2024,41(04):56-60.
[10] 许兴龙,周绿林.城乡居民主动参保行为驱动策略分析[J].中国医疗保险,2024,(10):24-28.
[11] YU Q, HE Y, LI L, et al.Study on the willingness to enroll in the urban and rural residents basic medical insurance: from the perspectives of policy awareness and institutional trust[J]. Frontiers in public health, 2025, 13.
[12] SAFITRI H, MUSTARUDDIN M, WENDY W, et al.Representativeness, mental accounting, overconfidence and loss aversion on investment decision: mediated by risk tolerance[C]//Universitas Tanjungpura, 2024.
[13] 刘晓婷,楼心怡.逆向选择还是正向选择:健康风险与风险态度对居民商业健康保险参保的影响研究[J].保险研究,2023(08):16-28.
[14] 王超群. 谁没有参保?中国城乡居民医疗保险参保的人群特征研究[J].社会保障评论,2023,7(02):76-93.
[15] 张仲芳,刘星.参加基本医疗保险与民众的“获得感”——基于中国综合社会调查数据的实证分析[J].山东社会科学,2020(12):147-152.
