Translating individual capacity into insurance protection: Policy Promotion Intensity as a communication-mediated mechanism shaping insurance plan adequacy among cancer patients in Sichuan, China

Abstract

Cancer financial toxicity represents a pressing concern in China, where over 4.82 million new cancer cases are diagnosed annually. Despite the achievement of near-universal health insurance coverage, the segmented system—encompassing Employee Basic Medical Insurance (EBMI) and Urban and Rural Resident Basic Medical Insurance (URRBMI)—continues to leave cancer patients exposed to substantial out-of-pocket expenditures, and the mechanisms linking individual capacity factors to insurance plan adequacy remain insufficiently understood. This study tests whether Policy Promotion Intensity (PPI) mediates the relationship between individual capacity factors and insurance plan adequacy among cancer patients in Sichuan Province, China. A cross-sectional survey was administered to 405 cancer patients recruited from tertiary, secondary, and primary healthcare facilities across Sichuan Province. Six constructs were operationalised: insurance literacy, health knowledge, prior insurance coverage, financial capability, policy promotion intensity, and choice of insurance plan. Data were analysed using confirmatory factor analysis and structural equation modelling in AMOS 23, with mediation effects tested via bias-corrected bootstrap confidence intervals based on 5,000 resamples. All five direct paths were statistically significant (p < .05), with financial capability exhibiting the strongest direct effect on plan adequacy (β = 0.267, p < .001). Policy promotion intensity significantly mediated all four pathways, with mediation proportions ranging from 12.7% (financial capability) to 25.4% (health knowledge). The model demonstrated excellent fit (CFI = 0.989, RMSEA = 0.020). These findings suggest that policy promotion intensity operates as a communication-mediated mechanism that amplifies but does not substitute for individual capacity in insurance decision-making. The results imply that hospital-based counselling, plain-language outreach, and tiered digital promotion calibrated to patient literacy levels may enhance insurance protection for cancer patients in segmented healthcare systems.