Zheng Zhangwei, B A M Hafizuddin-Syah, Zaki Hafizah Omar, Tan Qin Lingda
Faculty of Economics and Management, Universiti Kebangsaan Malaysia, Bangi, Selangor, 43600 UKM, Malaysia.
BMC Health Serv Res. 2025 Jun 2;25(1):788. doi: 10.1186/s12913-025-12917-0.
Health insurance plays a critical role in reducing financial burdens and improving healthcare access. However, misconceptions about risks and costs often lead to poor decision-making and low coverage, even in major economies. Understanding the factors influencing health insurance purchase intentions is essential for expanding coverage and addressing healthcare disparities. This study systematically reviews these factors to identify key patterns and research gaps.
A systematic review was conducted using the TCM (theory-context-methodology) and ADO (antecedent-decision-outcome) frameworks. Forty-eight studies published from 2014 to 2023 were analyzed to categorize influential factors based on theoretical models, geographic contexts, methodological approaches, and behavioral antecedents, decisions, and outcomes.
A total of 141 influential factors were identified across the reviewed studies, with a steady increase in publications over the decade. The TCM framework revealed the predominant use of the Theory of Planned Behavior, while research focused mainly on China, the United States, and India. The ADO framework highlighted behavioral antecedents as the most significant, followed by individual and financial factors, with purchase intention being the primary decision variable.
This review synthesizes current research on health insurance purchase intentions, identifying significant theoretical fragmentation and geographic disparities. It also provides recommendations for future research to explore underrepresented regions and emerging trends, with implications for expanding health insurance coverage and promoting healthcare equity.
医疗保险在减轻经济负担和改善医疗服务可及性方面发挥着关键作用。然而，即使在主要经济体中，对风险和成本的误解往往导致决策失误和保险覆盖率低下。了解影响医疗保险购买意愿的因素对于扩大保险覆盖范围和解决医疗保健差距至关重要。本研究系统地回顾了这些因素，以确定关键模式和研究空白。
使用中医（理论 - 背景 - 方法）和ADO（前因 - 决策 - 结果）框架进行系统回顾。分析了2014年至2023年发表的48项研究，根据理论模型、地理背景、方法学方法以及行为前因、决策和结果对影响因素进行分类。
在所审查的研究中总共确定了141个影响因素，在这十年间出版物数量稳步增加。中医框架显示计划行为理论的使用最为普遍，而研究主要集中在中国、美国和印度。ADO框架强调行为前因是最重要的，其次是个人和财务因素，购买意愿是主要的决策变量。
本综述综合了当前关于医疗保险购买意愿的研究，识别出显著的理论碎片化和地理差异。它还为未来研究提供了建议，以探索代表性不足的地区和新出现的趋势，这对扩大医疗保险覆盖范围和促进医疗公平具有重要意义。
