自由职业者社会医保参保行为影响因素研究

Research on Influencing Factors of Social Health Insurance Enrollment Behavior among Self-Employed Individuals

摘要: 在就业形式灵活化的时代背景下，鼓励灵活就业者参加社会医疗保险制度，是优化医疗制度参保结构，保障其基本医疗权益行之有效的办法，亦是数字经济时代就业形式转型过程中社会保障体系适应性调整的内在需求。本文使用中国家庭金融调查(CHFS)数据，分析自由职业者社会医保参保行为的影响因素。研究发现，自由职业者的平均每日工作时长每增加一小时，其选择参加城镇居民基本医疗保险的几率会增加17%，选择参加新型农村合作医疗保险的几率会增加16%，参保后选择断保的几率会降低17%。若自由职业者为互联网平台就业者，则其选择参加城镇居民基本医疗保险的几率会降低56%，选择参加新型农村合作医疗保险的几率会降低85%，选择断保的几率就会增加112%，选择新参保的几率会降低92%。自由职业者参加社会医疗保险不存在逆向选择现象。相反，当自由职业者健康状况变差时，其参加城镇职工基本医疗保险的几率会降低。建议优化参保激励机制，对工作时长较长的自由职业者，强化其参保动力。针对工作时长较低的低收入群体，降低其参保门槛。积极探索平台与从业者共同承担保费的新模式，建立和完善“助保”政策，优化制度间转移接续规则，最终建立覆盖全民的、统一的社会医疗保险制度。

Abstract: Against the backdrop of increasingly flexible employment patterns, encouraging flexible workers to participate in the social medical insurance system is an effective approach to optimizing the enrollment structure of the healthcare system and safeguarding their fundamental medical rights. It also represents an inherent requirement for the social security system to adapt to the transformation of employment forms in the digital economy era. This study utilizes data from the China Household Finance Survey (CHFS) to analyze the factors influencing freelancers’ participation in social medical insurance. Findings reveal that for every additional hour of average daily work time, freelancers’ probability of choosing to participate in the Urban Resident Basic Medical Insurance increases by 17%, their probability of choosing the New Rural Cooperative Medical Insurance increases by 16%, and their probability of discontinuing coverage after enrollment decreases by 17%. However, if the freelancer works for an internet platform, their probability of enrolling in the Urban Resident Basic Medical Insurance decreases by 56%, their enrollment in the New Rural Cooperative Medical Insurance drops by 85%, their probability of discontinuing coverage increases by 112%, and their likelihood of newly enrolling in any insurance falls by 92%. No adverse selection phenomenon exists among freelancers enrolling in social medical insurance. Conversely, when freelancers experience deteriorating health, their likelihood of enrolling in the Urban Employee Basic Medical Insurance decreases. It is recommended to optimize enrollment incentive mechanisms, strengthening enrollment motivation for freelancers with longer working hours. For low-income groups with shorter working hours, enrollment thresholds should be lowered. Actively explore new models where platforms and workers jointly bear premiums, establish and refine “subsidized insurance” policies, optimize transfer and continuity rules between systems, and ultimately build a unified social medical insurance system covering the entire population.