# The impact of risk information frameworks on cancer drug insurance (CDI) purchase decisions through time orientation and perceived risk: a survey-experiment study

## TL;DR

This study explores how different risk information frameworks influence people's decisions to buy cancer drug insurance in China, finding that high-risk information encourages more long-term insurance purchases.

## Contribution

The study introduces a novel survey-experiment framework to assess how risk information impacts cancer drug insurance decisions through time orientation and perceived risk.

## Key findings

- High-risk information frameworks (HRIF) significantly increased long-term cancer drug insurance (CDI) adoption compared to low-risk frameworks.
- Perceived risk mediated the relationship between time orientation and CDI purchase decisions under both risk information frameworks.
- HRIF reinforced future-oriented attitudes and reduced present-oriented behaviors, promoting CDI coverage.

## Abstract

China is actively promoting cancer drugs insurance (CDI) to alleviate the growing burden of cancer. However, the efficacy of risk information frameworks supplied to consumers in expanding CDI coverage remains poorly understood.

This study aimed to examine the impact of the risk information framework (RIF) on individuals’ CDI purchase decisions, as well as the roles played by time orientation and perceived risk within these frameworks.

This nationwide online survey enrolled 5,583 eligible participants aged from 18 to 60 years old in August 2025 in China. A randomized survey-based experiment with the designed risk information frameworks was conducted to elicit CDI purchase decisions. Participants were exposed to either a low-risk information framework (LRIF) or a high-risk information framework (HRIF) before making CDI purchase decisions. Descriptive statistics and mediating effect models were used to analyze participants’ decisions to purchase CDI.

Among 2,825 eligible participants in LRIF, 364 (12.9%) were not insured by CDI, and 1,507 (53.3%) were insured by long-term CDI schemes (selected the option of 3 years). Among 2,758 eligible participants in HRIF, 99 (3.6%) were not insured by CDI, and 1881 (68.2%) were insured by long-term CDI schemes. Under LRIF, the mediating effects of perceived risk between present-oriented attitude and CDI purchase were −0.030 [95%CI: −0.072, −0.003], and between future-oriented attitude and CDI purchase were 0.089 [95%CI: 0.064, 0.118]. Under HRIF, the corresponding mediating effects of perceived risk were −0.006 [95%CI: −0.024, −0.001] and 0.022 [95%CI: 0.010, 0.038].

HRIF could stimulate an individual’s CDI adoption. The underlying mechanism may be that HRIF restrains a present-oriented attitude and reinforces a future-oriented one, with perceived risk as a mediating factor. These findings underscore the need to emphasize RIF designs to promote CDI coverage.