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Health Insurance Satisfaction, Financial Burden, Locus of Control, and Quality of Life of Cancer Patients: A Moderated Mediation Model

Saeed Pahlevan Sharif
Navaz Naghavi
Hamid Sharif Nia
Fon Sim Ong
Hassam Waheed

Even though cancer survival rates have increased over the past few decades, however, cancer patients long endure physical, emotional and financial pressures even after complete remission. To date, efforts to restore quality of life (QoL) of cancer patients have primarily focused upon expanding health insurance coverage. However, in a country like Iran, the usefulness of health insurance coverage is limited due to the insufficiency of health insurance packages. Given the aforementioned, and the fact that choice of health insurance is under cancer patients’ volitional control, it is surprising to note that research has largely ignored the relationship between cancer patients’ satisfaction with their health insurance and their QoL. The present research therefore sought to examine this nexus in context of cancer patients in Iran. Furthermore, the present study examined whether health insurance satisfaction improves QoL by reducing financial burden and whether lack of volitional control (i.e., external locus of control [LoC]) exacerbates the adverse impact of financial burden on QoL of cancer patients.

Data for the present study came from the Financial Literacy of Cancer Patients’ project collected through two independent surveys in Iran. The project utilised questionnaire-based survey in which, participants rated a series of statements on a given scale at one specific time period. In total, 387 valid responses were obtained from cancer patients who conveniently participated in the survey and were at least 18 years old.

The results indicated that cancer patients who are more satisfied with their health insurance perceive lower financial burden related to their disease and they then experience a higher QoL.

Additionally, cancer patients with high external LoC experience a lower QoL, potentially due to ineffective coping strategies associated with their disease. At the same time however, external LoC can lead to better QoL. In fact, when cancer patients attribute their chronic condition to fate or other external factors, they may feel responsible for their condition. Such an outlook dampens the detrimental impact of perceived financial burden on QoL of cancer patients.

The results highlight several policy implications. First, insurance organizations need to define the baseline expectations which are mostly set by laws, regulations, and industry standards. For example, the ‘gray areas’ of payments in the health system in Iran should be addressed, as many services are not clearly inscribed if they are under the insurance coverage. Secondly, insurance organisations should present accurate, consistent, and up-to-date information, in a non-technical language that is understandable by consumers, in marketing campaigns, public statements, brochures, social marketing initiatives, and on their websites. Doing so would align customers’ expectations with reality. For this reason, all agents and staff involved in direct communications with customers need to be appropriately trained. Finally, insurance companies are recommended to revise their strategies, communications, staff training programs through customers and healthcare providers’ feedback to reduce inconsistency between customers’ expectations and offered services.