DRIVING FACTORS OF COMMERCIAL HEALTH INSURANCE PARTICIPATION INTENTION IN CHINA UNDER POPULATION AGING: DISTINCT EFFECTS OF INDIVIDUAL COGNITION AND RISK PERCEPTION

Authors

  • Xia Zhang
  • Chun-Shuo Chen

DOI:

https://doi.org/10.18623/rvd.v23.7831

Keywords:

Population Aging, Service Quality, Strong Tie, Individual Cognition, Risk Perception

Abstract

Against the backdrop of deepening population aging and rising demand for medical security in China, Service Quality (SQ)and Strong Tie (ST) are key factors in boosting the intention to purchase commercial health insurance. This study conducts empirical analysis to test research hypotheses based on 565 valid online samples. The findings indicate that both factors significantly increase Participation Intention (PI). Individual Cognition (IC) partially mediates their relationships, while Risk Perception (RP) exerts a positive moderating effect. This research enriches the theoretical framework and clarifies synergies between core variables, offering empirical evidence and practical references for insurers to improve services, expand marketing channels and raise enrollment rates.

References

Ajzen, I. (1991). The Theory of planned behavior. Organizational Behavior and Human Decision Processes.https://doi.org/10.4135/9781446249215.n22

Banks, J., & Oldfield, Z. (2007). Understanding pensions: Cognitive function, numerical ability and retirement saving. Fiscal studies, 28(2), 143-170. https://doi.org/10.1111/j.1475-5890.2007.00052.x

Becker-Leifhold, C. V. (2018). The role of values in collaborative fashion consumption: A critical investigation through the lenses of the Theory of Planned Behavior. Journal of Cleaner Production, 199, 781-791. https://doi.org/10.1016/j.jclepro.2018.06.218

Binswanger, J., & Salm, M. (2017). Does everyone use probabilities? The role of cognitive skills. European Economic Review, 98, 73-85. https://doi.org/10.1016/j.euroecorev.2017.06.009

Bottazzi, L., & Lusardi, A. (2021). Stereotypes in financial literacy: Evidence from PISA. Journal of Corporate Finance,71,101831. https://doi.org/10.1016/j.jcorpfin.2021.101831

Buldeo Rai, H., Verlinde, S., Macharis, C., Schoutteet, P. and Vanhaverbeke, L. (2019), "Logistics outsourcing in omnichannel retail: State of practice and service recommendations". International Journal of Physical Distribution & Logistics Management,49(3).267-286. https://doi.org/10.1108/IJPDLM-02-2018-0092

Chen Y.,Kong X.Z., & Zhao G.Q.(2024).Perception of Risk and Commercial Health Insurance Participation.Finance Forum,29(2),70-80.https://doi.org/10.16529/j.cnki.11-4613/f.2024.02.006

Chimedtseren, E., & Safari, M. (2016). Service Quality factors affecting purchase intention of life insurance products. Journal of Insurance and Financial Management, 1(1), 1-12. https://ssrn.com/abstract=2890792

Cnaan, R. A., Kang, C. H., Kim, K.-S., & Lee, L. H. J. (2014). Informal Social Networks in Korea: Covering the cost of major life events. The Social Science Journal, 51(4), 627-637. https://doi.org/10.1016/j.soscij.2014.01.006

Comrey, A. L., & Lee, H. B. (2013). A First Course in Factor Analysis. Psychology Press. https://doi.org/10.4324/9781315827506

E X & Yuqi Y.(2025).Smart Elderly Health Care and Medical Expenses: Evidence from the Smart Elderly Health Care Demonstration Sites.Journal of Management World,41(1),108-130.https://doi.org/10.19744/j.cnki.11-1235/f.2025.0014

Etner, J., & Jeleva, M. (2013). Risk Perception, prevention and diagnostic tests. Health economics, 22(2), 144-156. https://doi.org/10.1002/hec.1822

Gao, J., Pimdee, P., & Sukkamart, A. (2026). Antecedents of student loyalty in chinese vocational undergraduate universities. Veredas do Direito, 23(10), e236914-e236914

Gao, L., Nie, Y., Wang, G., & Li, F. (2022). The impact of public health education on people's demand for commercial health insurance: Empirical evidence from China. Frontiers in Public Health, 10, 1053932.https://doi.org/10.3389/fpubh.2022.1053932

Gün, İ., & Söyük, S. (2025). The serial mediation effect of perceived quality and customer satisfaction on the relationship between trust and repurchase intention: a research on private health insurance owners. BMC Health Services Research, 25(1), 257.https://doi.org/10.1186/s12913-025-12269-9

Han, K., & Tan, J. (2021). How neighbours influence commercial health insurance purchase: evidence from 2451 rural households in west China. Journal of Development Effectiveness, 13(3),329–341. https://doi.org/10.1080/19439342.2021.1953569

Hayes, A. F. (2022). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach (4th ed.). Guilford Press. https://doi.org/10.4135/9781071817474

Hayes, A. F., & Little, T. D. (2018). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach (Second edition). The Guilford Press.

Hoang, N. V., Tam, N. T., & La, N. T. (2026). Corporate social responsibility (CSR): From voluntary commitment to mandatory obligation. Veredas do Direito, 23(10), e237166-e237166

Kim, H. W., Xu, Y., & Gupta, S. (2012). Which is more important in Internet shopping, perceived price or trust?. Electronic Commerce Research and Applications, 11(3), 241-252. https://doi.org/10.1016/j.elerap.2011.06.003

Lee, S. E., Kim, S. J., Oh, K. W., & Lee, K. H. (2022). Purchase intention toward sustainable masks after COVID-19: the moderating role of health concern. Fashion and Textiles, 9(1), 43.DOI:10.1186/s40691-022-00317-5

Leon, S. and Choi, H. (2020), "Satisfaction and word-of-mouth moderated by choice: a service industry perspective", Journal of Consumer Marketing, 37(7), pp. 869-881. https://doi.org/10.1108/JCM-08-2019-3369

Lusardi, Annamaria, and Olivia S. Mitchell. 2014. "The Economic Importance of Financial Literacy: Theory and Evidence." Journal of Economic Literature, 52(1).5–44.DOI: 10.1257/jel.52.1.5

Maman, D., & Rosenhek, Z. (2020). Facing future uncertainties and risks through personal finance: Conventions in financial education. Journal of Cultural Economy, 13(3), 303-317. https://doi.org/10.1080/17530350.2019.1574865

Masud, M. M., Ahsan, M. R., Ismail, N. A., & Rana, M. S. (2021). The underlying drivers of household purchase behaviour of life insurance. Society and Business Review, 16(3), 442-458. https://doi.org/10.1108/SBR-08-2020-0103

Morgan, P. J., & Long, T. Q. (2020). Financial literacy, financial inclusion, and savings behavior in Laos. Journal of Asian Economics, 68, 101-197. https://doi.org/10.1016/j.asieco.2020.101197

Munir, I. U., Yue, S., Ijaz, M. S., Hussain, S., & Zaidi, S. Y. (2024). Financial literacy and stock market participation: Does gender matter? The Singapore Economic Review, 9(2), 73-92. https://doi.org/10.1108/singeco-2020-0004

Olonila, A. A., Igbatayo, S. A., & Awoyemi, B. O. (2026). Monetary policy and economic growth in emerging economies: investigating major channels. Veredas do Direito, 23(9), e236654-e236654

Omar, S., Mohsen, K., Tsimonis, G., Oozeerally, A., & Hsu, J.-H. (2021). M-commerce: The nexus between mobile shopping Service Quality and loyalty. Journal of Retailing and Consumer Services,60, 102468. https://doi.org/10.1016/j.jretconser.2021.102468

Panigrahi, S. K., Azizan, N. A., & Khan, M. W. A. (2018). Investigating the empirical relationship between Service Quality, trust, satisfaction, and intention of customers purchasing life insurance products. Indian Journal of Marketing, 48(1), 28–46.DOI: 10.17010/ijom/2018/v48/i1/120734

Quintal, V. A., Lee, J. A., & Soutar, G. N. (2010). Risk, uncertainty and the theory of planned behavior: A tourism example. Tourism Management,31(6), 797-805. https://doi.org/10.1016/j.tourman.2009.08.006

RamirezCorrea, P., RondanCataluna, F. J., Moulaz, M. T., & ArenasGaitan, J. (2020). Purchase Intention of Specialty Coffee. Sustainability,12(4), 1-21. DOI:10.3390/su12041347

Shen, T., Wang, Y., Xie, J., Han, X., Shao, R., & Jiang, R. (2023). Correlates of residents' enrolment intention toward inclusive commercial health insurance in China: involvement, perceived benefit, perceived sacrifice, and government participation. Frontiers in Public Health, 11, 1121783. https://doi.org/10.3389/fpubh.2023.1121783.

Slovic, P. (1987). Perception of risk. science, 236(4799), 280-285.

Sun, D., Chen, W., & Dou, X. (2024). Formation mechanism of residents' intention to purchase commercial health insurance: The moderating effect of environmental pollution perception. Journal of Public Health, 32, 917–930. https://doi.org/10.1007/s10389-023-01870-z

Thamtarana, K., & Sornsaruht, P. (2024). Antecedents to Thai Consumer Insurance Policy Purchase Intention: A Structural Equation Model Analysis.Sage Open, 14(1). https://doi.org/10.1177/21582440241239474

Uzir, M. U. H., Al Halbusi, H., Thurasamy, R., Hock, R. L. T., Aljaberi, M. A., Hasan, N., & Hamid, M. (2021). The effects of Service Quality, perceived value and trust in home delivery service personnel on customer satisfaction: Evidence from a developing country. Journal of Retailing and Consumer Services, 63, 102721. https://doi.org/10.1016/j.jretconser.2021.102721

Wang Mengzhen. & Li Wenjun.(2024).Assessment and Planning of Personal Retirement Financing Based on Life Cycle Theory.Journal of Financial Research,(7),170-187. http://www.jryj.org.cn/CN/Y2024/V529/I7/170

Wang, H., Li, J., Mangmeechai, A., & Su, J. (2021). Linking perceived policy effectiveness and proenvironmental behavior: The influence of attitude, implementation intention, and knowledge. International Journal of Environmental Research and Public Health, 18(6), 2910. https://doi.org/10.3390/ijerph18062910

Weerdt, J. D., & Fafchamps, M. (2011). Social identity and the formation of health insurance networks. Journal of Development Studies, 47(8), 1152-1177.https://doi.org/10.1080/00220388.2010.527952

Weidi P. & Hui Y. (2021).Clan Mutual Assistance and Commercial Health Insurance Demand.Journal of Finance and Economics,47(5),34-48.https://doi.org/10.16538/j.cnki.jfe.20210313.102

Wu, X., Zhao, J. (2020).Risk sharing, siblings, and household equity investment: evidence from urban China. Journal of Population Economics, 33(2), 461–482. https://doi.org/10.1007/s00148-019-00740-x

Xu, S., Ali, S. T., Yang, Z., & Li, Y. (2023). Effect of household's financial literacy on pension decision making: evidence from China's new rural pension program. Kybernetes, 52(10), 4611-4644.DOI:10.1108/k-03-2022-0321

Xu, S., Wang, J., & Cao, N. (2024). Study on the influencing factors of fishery producers' willingness to participate in aquaculture insurance--based on the perspective of subjective norms and Risk Perception. Aquaculture and Fisheries. https://doi.org/10.1016/j.aaf.2024.04.002

Xu, X., Wang, S., & Yu, Y. (2020). Consumer’s intention to purchase green furniture: Do health consciousness and environmental awareness matter?. Science of the Total Environment, 704, 135275. https://doi.org/10.1016/j.scitotenv.2019.135275

Yinghui L.(2020).Strong Tie Dominance and Dual Resource Acquisition: An Analysis of Youth Groups' Social Network Use in the Process of Entrepreneurship.China Youth Study,(7),96-104.https://doi.org/10.19633/j.cnki.11-2579/d.2020.0107

Yu, L., Mottola, G., Wilson, R. S., Valdes, O., Bennett, D. A., & Boyle, P. A. (2022). Metamemory and financial decision making in older adults without dementia. Neuropsychology, 36(1), 35-43.https://doi.org/10.1037/neu0000773

Zagorcheva, D., Pavlov, D., Wójcik-Karpacz, A., Alieva, D., & Murzina, J. (2026). Family as a source of emotional health and entrepreneurial support. Veredas do Direito, 23(10), e236184-e236184

Zeithaml, V. A. (1988). Consumer perceptions of price, quality, and value: a means-end model and synthesis of evidence. Journal of Marketing, 52(3), 2-22. https://doi.org/10.1177/002224298805200302

Zhou, Y., Furuoka, F., & Kumar, S. (2024). Promoting electronic customer-to-customer interaction: evidence from social commerce sites. The Service Industries Journal, 44(11-12), 873-899.https://doi.org/10.1080/02642069.2022.2113780

Downloads

Published

2026-08-03

How to Cite

Zhang, X., & Chen, C.-S. (2026). DRIVING FACTORS OF COMMERCIAL HEALTH INSURANCE PARTICIPATION INTENTION IN CHINA UNDER POPULATION AGING: DISTINCT EFFECTS OF INDIVIDUAL COGNITION AND RISK PERCEPTION. Veredas Do Direito, 23(13), e7831. https://doi.org/10.18623/rvd.v23.7831

Issue

Vol. 23 No. 13 (2026): Veredas do Direito, v. 23, n. 13 2026

Section

Articles

License

I (we) submit this article which is original and unpublished, of my (our) own authorship, to the evaluation of the Veredas do Direito Journal, and agree that the related copyrights will become exclusive property of the Journal, being prohibited any partial or total copy in any other part or other printed or online communication vehicle dissociated from the Veredas do Direito Journal, without the necessary and prior authorization that should be requested in writing to Editor in Chief. I (we) also declare that there is no conflict of interest between the articles theme, the author (s) and enterprises, institutions or individuals.

I (we) recognize that the Veredas do Direito Journal is licensed under a CREATIVE COMMONS LICENSE.

 

Licença Creative Commons Attribution 3.0