Chi Hongmei, Hazlina Binti Abd Kadir, Rosman Bin Karim
Perinatal Journal - 2025;33(3):57-68
Cancer patients face complex and high-stakes decisions when selecting health insurance plans, and these choices significantly influence access to treatment and financial protection. This PRISMA-guided systematic review synthesized evidence from 14 empirical studies published between 2000 and 2025 to identify determinants of health insurance plan choice among cancer patients in China and in international contexts. Findings reveal four consistent determinant domains: insurance literacy and health knowledge, financial capability, prior insurance experience, and policy promotion intensity. Higher literacy and better understanding of insurance benefits were strongly associated with informed plan decisions, while financial vulnerability, particularly among low-income patients, reduced the likelihood of purchasing supplemental coverage and increased the risk of insurance lapses. Prior coverage influenced trust, familiarity, and confidence in navigating new insurance options. Importantly, policy promotion intensity emerged as a distinctive system-level determinant in China, where government-led outreach significantly increased enrollment in programs such as Huiminbao. Compared with market-based systems like the United States, China's hybrid governance structure amplified the impact of institutional trust and public communication on patient behaviors. Overall, the review highlights the need for stronger insurance literacy interventions, targeted financial support, and transparent, patient-centered policy communication to improve equitable insurance participation for cancer patients.
