Insurance Plan Choice among Cancer Patients in China: A Structured Narrative Review and Research Agenda

© 2025 by the Authors. Licensee Whioce Publishing, Singapore. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )

Download PDF

Cite

XML

HTML

Abstract

Cancer patients in China navigate a complex and uneven insurance landscape, making plan choice critical for equitable financial protection. This study conducts a structured narrative review (2010–2025) of the Web of Science, PubMed, CNKI, and Wanfang databases, focusing on empirical research on insurance plan choice, enrollment, or switching among cancer patients and their households in China. Two reviewers independently screened studies and extracted information on key determinants and identification strategies. The evidence converges on five main determinants: insurance literacy, health knowledge, prior coverage, financial capability, and policy promotion intensity (PPI). However, most studies are cross-sectional and descriptive, with inconsistent operationalization of determinants, weak or absent mediation tests for PPI, and limited coverage of rural, elderly, and low-literacy populations. Building on these gaps, we synthesize an evidence map, propose an operational PPI index, and highlight quasi-experimental opportunities (such as staggered NRDL updates and variation in local publicity efforts) to identify mechanisms and inform more inclusive, patient-centered insurance design in China.

References

Wagstaff A, Flores G, Hsu J, 2018, Progress on Catastrophic Health Spending in 133 Countries: A Retrospective Observational Study. The Lancet Global Health, 6(2): e169–e179.

Fan V, Karan A, Mahal A, 2012, State Health Insurance and Out-of-Pocket Health Expenditures in Andhra Pradesh, India. International Journal of Health Care Finance & Economics, 12(3): 189–215.

Meng Q, Xu L, Zhang Y, 2012, Trends in Access to Health Services and Financial Protection in China Between 2003 and 2011: A Cross-Sectional Study. The Lancet, 379(9818): 805–814.

Paez K, Mallery C, Noel H, 2014, Development of the Health Insurance Literacy Measure (HILM): Conceptualization and Measurement of Consumers’ Ability to Select and Use Health Insurance. Journal of Health Communication, 19(Suppl 2): 225–239.

He W, 2023, Social Medical Insurance Integration and Health Care Disparities in China: Evidence from an Administrative Claim Dataset. Economic Analysis and Policy, 79: 20–39.

Braun R, Zhu Y, Anderson G, 2018, Insurance Literacy and Health Care Utilization. Journal of General Internal Medicine, 33(6): 1023–1030.

Kim H, Lee J, Park S, 2020, The Role of Health Knowledge in Health Insurance Plan Choice. Patient Education and Counseling, 103(9): 1784–1792.

Liu F, Zhang W, Chen S, 2023, Financial Capability and Demand for Supplementary Health Insurance in China. Journal of Financial Services Marketing, 16(4): 501–520.

An Z, Wei J, Guo F, 2023, Public Policy Promotion and Health Insurance Participation: Evidence from Community Campaigns. Journal of Health Communication, 28(5): 455–472.

Zhou L, Xu J, Huang T, 2024, Policy Promotion Intensity and Enrollment in Medical Insurance Schemes: A Multi-Province Study. Health Economics Review, 14(2): 201–218.

Blumenthal D, Hsiao W, 2015, Lessons from the East—China’s Rapidly Evolving Health Care System. New England Journal of Medicine, 372(14): 1281–1285.

Yip W, Hsiao W, 2015, What Drove the Cycles of Chinese Health System Reforms? Health Systems & Reform, 1(1): 52–61.

Kwon S, 2020, Health Insurance and Financial Protection in Middle-Income Countries. Health Policy and Planning, 35(2): 167–175.

Cutler D, Zeckhauser R, 2000, The Anatomy of Health Insurance. Handbook of Health Economics, 1(11): 563–643.

Adepoju O, Makanjuola V, Adediran O, 2021, Insurance Literacy and Enrollment in Social Health Insurance Programmes: Evidence from Low-Income Settings. Health Policy and Planning, 36(5): 654–662.

Zhang Y, Li H, Xu R, 2023, Health Knowledge, Patient Navigation and Insurance Decisions in Chronic Disease Management. Health Economics & Policy, 8(2): 45–59.

McGarvey C, Taylor M, O’Donnell P, 2023, Prior Coverage, Switching Behaviour and Insurance Plan Loyalty. Health Services Research, 58(1): 112–129.

Wang J, Zhao X, Li Q, 2021, Prior Insurance Coverage and the Demand for Critical-Illness Products: Evidence from China. China Economic Review, 67: 101604.

Loibl C, Hira T, 2011, Know Your Subject: Financial Literacy and the Quality of Financial Services. Journal of Consumer Affairs, 45(2): 385–402.

Lusardi A, Mitchell O, 2014, The Economic Importance of Financial Literacy: Theory and Evidence. Journal of Economic Literature, 52(1): 5–44.

Abrams E, Wang Y, Silver K, 2021, Financial Planning Behaviour Among Patients with Chronic Illnesses. Social Science & Medicine, 282: 114125.

Rosenstock I, 1974, Historical Origins of the Health Belief Model. Health Education Monographs, 2(4): 328–335.

Janz N, Becker M, 1984, The Health Belief Model: A Decade Later. Health Education Quarterly, 11(1): 1–47.

Ajzen I, 1991, The Theory of Planned Behavior. Organizational Behavior and Human Decision Processes, 50(2): 179–211.

Conner M, Sparks P, 2005, Theory of Planned Behaviour and Health Behaviour. Predicting Health Behaviour, 170–222.

Kahneman D, Tversky A, 1979, Prospect Theory: An Analysis of Decision under Risk. Econometrica, 47(2): 263–291.

Thaler R, Sunstein C, 2008, Nudge: Improving Decisions About Health, Wealth, and Happiness. Yale University Press, New Haven & London.

Previous article in this issue

Next article in this issue