During the legislative process of the Healthcare Security Law, whether basic medical insurance for urban and rural residents should establish a compulsory enrollment obligation has become a focus of controversy. This paper, after reviewing the main arguments of compulsory enrollment versus voluntary enrollment and summarizing foreign legal practices regarding universal compulsory coverage, conducts an analysis at two levels. At the theoretical level, it argues that compulsory enrollment serves as an institutional guarantee for citizens' right to social security, transforming it from a normative right into a practical reality, and preventing individuals from making enrollment decisions that are detrimental to themselves and society as a whole due to incomplete information and bounded rationality. At the practical level, it demonstrates that compulsory enrollment is conducive to the sustainable development of the medical insurance system, reduces collection difficulties and administrative costs, and helps prevent the insured from falling into or back into poverty due to illness. Furthermore, this paper conducts a classified profiling and attribution analysis of the major obstacles to implementing compulsory enrollment, and recommends that, when formulating the Healthcare Security Law, China should extensively draw upon foreign legal experiences with compulsory coverage, introduce a universal compulsory enrollment clause, and continuously improve the existing healthcare security system.
Key words
urban and rural residents’ basic medical insurance /
universal coverage /
compulsory enrollment /
system optimization
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