借鉴“三角四方”医保行为关系理论和“成本—收益”理论，基于湖南省5市15个行政村513位参保农民样本，研究参保农民的城乡居民基本医疗保险满意度及其影响因素，结果表明：城乡医保制度福利效应显现，实现了从“低水平”向“保基本”的转变，但与参保农民预期和理想的状态还存在较大差距；医保缴费报销制度合理性、医疗服务价值感知和政府支持力度在促进参保农民城乡医保满意度提升方面存在正向且非均衡性效应，其中医疗服务价值感知促进效应最大，医保缴费报销制度合理性次之，政府支持力度促进效应最小，反映出当前参保农民对医疗成本收益考量的重点由缴费报销制度物质性收益向医疗机构的服务性收益变迁，对城乡医疗保险的关注由单一的保障性政策领域逐渐向多元的医疗服务领域演进的趋势。

Based on the medical insurance behavioral relationship theory of “Triangular Four Parties ”interacting among the insured (service demander), the insurer (insurance institutions), the medical service supplier (including designated hospitals and pharmacies) and the government and the "Cost-Benefit" theory, the article explores the insured farmers’ satisfaction with the basic medical insurance for urban and rural residents and its influencing factors by taking 513 insured farmers from 15 administrative villages in 5 cities in Hunan Province as samples .The results show that with the emergence of the welfare effects, the basic medical insurance service for urban and rural residents has transformed from "low level" to "basic guarantee" , but a big gap exists between the insured farmers’ expected ideal state and the practice. The rationality of medical insurance payment and reimbursement system, the medical service value perception and government support have positive and imbalanced effects on enhancing the insured farmers’ satisfaction with the basic medical insurance for urban and rural residents, among which medical service value perception exerts the greatest influence, followed by the rationality of the medical insurance payment and reimbursement system, and government support has the smallest impact, reflecting that the focus of current insured farmers’ consideration about the medical costs and benefits changes from material benefits of the payment reimbursement system to the service benefits of medical institutions ,and the holistic concern for the medical insurance for urban and rural residents tend to evolve from a single protective policy field to multiple medical services.

C912.82