研究背景及目的：医保电子凭证制度实行至今，优化了患者的诊疗流程，为广大居民基本医疗需求提供帮助。但眼下仍存在注册人数较低、推广范围窄等问题。如何解决医疗服务电子化政策推行缓慢的现状，成为政策制定及管理者务须思考的问题。本研究以北京市医保注册居民为研究对象，从政策认同的视角，探究医保注册居民注册参与医保电子凭证制度的情况，对该制度的认知及评价情况，以及居民认知及评价情况对居民注册参与医保电子凭证的影响，并根据数据分析结论。

研究方法：查阅了医保电子凭证和政策认同研究相关的文献资料后，基于帕森斯社会系统理论并提出了研究假设，主要假设如下：第一：医保电子凭证参与情况在本市医保注册居民中存在人口学差异；第二：居民对医保电子凭证政策的认同对其注册医保电子凭证有显著影响。

本研究以人口学变量、政策认同为自变量，居民是否注册医保电子凭证为因变量，以此构建研究模型。并通过研究假设设计问卷，通过问卷星收集数据，最终获取467份有效样本问卷。此后研究中使用SpssSPSS软件对数据进行分析进行统计分析，运用均值、频数、百分比、卡方检验、相关分析等方法进行描述性分析和相关性分析。，最后运用二元Logistic回归分析进行建模，将差异性分析中的人口学变量以及政策认同变量一起纳入模型，分析探究政策认同与医保注册居民注册医保电子凭证影响因素相关关系。

研究结果：模型2在模型1的基础上，纳入了政策认知、政策评价各变量，依次考察在纳入控制变量的前提下，政策认同感对居民选择使用医保电子凭证的影响。二元Logistic回归发现，纳入政策认知、政策评价各变量后，家庭年收入与、是否患慢性病与居民选择使用医保电子凭证存在显著相关关系。具体而言：与家庭年收入1-5万相比，家庭年收入20万以上居民更倾向于拒绝选择使用医保电子凭证（OR 0.086，95%CI [0.008-0.947]）；与患慢性病居民相比，未患慢性病居民更倾向于拒绝选择使用医保电子凭证（OR 0.141，95%CI [0.027-0.734]）。政策信息认知会对与居民选择使用医保电子凭证产生显著的正向影响相关关系（OR 4.911，95%CI [2.085-11.567]），同样产生存在正向影响相关关系的包括基础功能认知（OR 2.192，95%CI [1.061-4.528]）、优化公共服务评价（OR 2.69，95%CI [1.185-6.103]）；功能优势评价会对与居民选择使用医保电子凭证产生显著的反向影响负向相关关系（OR 0.451，95%CI [0.204-0.997]）。

结论与建议：经过数据分析和讨论，得出如下研究结论：第一、人口学变量方面，不同户籍类型、学历的医保注册居民在选择使用医保电子凭证医保注册人群在注册使用医保电子凭证方面存在显著差异。家庭年收入1-5万相比，家庭年收入20万以上居民更倾向于拒绝选择使用医保电子凭证。第二，政策认同相关变量方面,在政策认同感影响下，与家庭年收入1-5万相比，家庭年收入20万以上居民更倾向于拒绝选择使用医保电子凭证；与患慢性病居民相比，未患慢性病居民更倾向于拒绝选择使用医保电子凭证。此外，居民对政策信息认知、基础功能认知成就动机、、优化公共服务评价创新公共服务评价会对与医保注册人群居民选择使用参与医保电子凭证行为产生正向影响存在正向相关关系，而功能优势评价与居民选择使用医保电子凭证产生显著的负向相关关系创新功能认知对医保注册人群参与医保电子凭证产生负向影响。

根据研究结论，提出以下建议：推广医保电子凭证政策，应加强政策指导，增进居民的政策认知；协调利益，以政策为居民医保支付活动赋能；奖惩相济，保障居民参与政策制度安全可靠。通过强化政策对象在政策执行中的认同感，帮助医保电子凭证制度持续健康发展。

Background and Objective: Since the implementation of the medical insurance electronic voucher system, the diagnosis and treatment process of patients has been optimized, which also provides assistance for the basic medical needs of the majority of residents. However, there are still problems, such as low registered amount and narrow promotion scale. Therefore, how to solve the slow promotion of electronic medical service policy has become a problem for policy makers and governors to consider. Taking the registered medical insurance residents of Beijing as the research object, from the perspective of policy identification.

 this study explore the situation of registered residents using the participating medical insurance electronic voucher system,as well as their cognition and evaluation of the system.  and the impact of residents’ understanding and evaluation on their registration and use of participating medical insurance electronic voucher system.In addition, it strives to draw a conclusion in line with the data analysis.

 Research methods: After browsing references related to medical insurance electronic voucher and policy identity research, the research hypothesis below is put forward based on Parsons' theory of social systems.First, there is a demography difference in involvement situation of medical insurance electronic voucher among city residents who registered medical insurance. Second, there is a significant effect of city residents identity on their registration and use of medical insurance electronic voucher.

In this research, demography variable and policy identity are taken as independent variable. Whether or not the residents register and use electronic medical insurance vouchers is taken as dependent variable. Research model is built therefrom. Through questionnaire designed by research hypothesis and data collected by WJX.CN, 467 valid questionnaires are obtained. And then, SPSS software is used to analyze data and methods such as mean, frequency, percentage, chi-square test and correlation analysis are used to conduct descriptive analysis and correlation analysis. At last, binary Logistic regression analysis is used to incorporate demography variable and policy identity variable in difference analysis into the model, in order to explore the relationship between policy identity and whether or not residents with medical insurance are willing to register and use medical insurance electronic vouchers.

Results: Binary logistic regression found that after taking into account all variables of policy cognition and policy evaluation. There is significant correlation between household annual income, chronic disease and residents of electronic medical insurance vouchers. To be specific, compared with the annual household income of 10,000 to 50,000 yuan, residents with annual household income of 200,000 yuan or more are more likely to refuse to use the electronic medical insurance vouchers (OR 0.086, 95%CI [0.008-0.947]). Compared with residents with chronic diseases, residents without chronic diseases are more likely to refuse to use electronic medical insurance vouchers (OR 0.141, 95%CI [0.027-0.734]). Residents’ cognition of policy information and basic functions. Cognition of policy information has a significant positive impact on residents of electronic medical insurance vouchers (OR 4.911, 95%CI [2.085-11.567]); In addition, cognition of basic functions (OR 2.192, 95%CI [1.061-4.528]) and optimized public service evaluation (OR 2.69, 95%CI [1.185-6.103]) also has a positive impact on the use of electronic medical insurance vouchers; There is a significant negative correlation between functional advantage evaluation and residents of electronic medical insurance vouchers (OR 0.451, 95%CI [0.204-0.997]).

Conclusions and Suggestions:There are significant differences in the use of electronic medical insurance vouchers among registered medical insurance residents with different household registration types and educational backgrounds. Compared with the annual household income of 10,000 to 50,000 yuan, residents with an annual household income of 200,000 yuan or more are more likely to refuse to use electronic medical insurance vouchers. Compared with residents with chronic diseases, residents without chronic diseases are more likely to refuse to use electronic medical insurance vouchers. In addition, residents’ cognition of policy information and basic functions as well as evaluation of optimized public services are positively correlated with residents of medical insurance electronic vouchers, while functional advantage evaluation is significantly negatively correlated with residents of medical insurance electronic vouchers.

According to research conclusion, the following suggestions are proposed. In order to promote medical insurance electronic voucher policy, it is necessary to strengthen policy guidance and improve residents’ policy awareness; It is necessary to coordinate benefits and empower residents’ medical insurance payment activities with policy; It is necessary to work along both reward and punishment and ensure the safety and reliability of residents' involvement in policy system. In order to achieve a sustained and healthy development of medical insurance electronic voucher system, it is necessary to enhance the policy targets’ sense of identity in policy implementation.