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Received 26 May 2022, accepted 28 June 2022, date of publication 1 July 2022, date of current version 11 July 2022.
Digital Object Identifier 10.1109/ACCESS.2022.3187711
Exploring the Intention of Middle-Aged and
Elderly Consumers to Participate in Inclusive
Medical Insurance
DAN LI1, JIE LV1, LIANGCHEN JING1, CONG CAO 1, (Member, IEEE), AND YANGYAN SHI2
1School of Management, Zhejiang University of Technology, Hangzhou, Zhejiang 310023, China
2Department of Management, Macquarie University, Sydney, NSW 2109, Australia
Corresponding author: Cong Cao (congcao@zjut.edu.cn)
This work was supported in part by the Zhejiang University of Technology Subject Reform Project under Grant SKY-ZX-20210175, and in
part by the General Scientific Research Projects of the Zhejiang Provincial Education Department under Grant Y202147535.
This work involved human subjects or animals in its research. Approval of all ethical and experimental procedures and protocols was
granted by the School of Management, Zhejiang University of Technology, China.
ABSTRACT With the sudden and heavy consequences of diseases, medical insurance has become a vital
part of the medical system. Inclusive medical insurance (IMI) aims to help people manage personal health
risks from an economic perspective under the cooperation of government and private enterprises. With
the worsening aging phenomenon in China, middle-aged and elderly consumers inevitably need to choose
insurance services. However, the diversification of service forms and contents implies potential loopholes
that may affect their intention to participate in insurance. In this study, we establish a trust mechanism model
combining finance, technology, and institutions; collect and organize data using questionnaires; and explore
the link between trust and intention to participate in IMI. Our results show that new service concepts under
digital channels can increase financial trust, perceived ease of use affects technical trust, and reputation
and security mechanisms positively affect institutional trust. Furthermore, trust transfer occurs among the
three types of trust. At the same time, financial trust and institutional trust positively affect middle-aged and
elderly consumers’ intention to participate in insurance. The findings of our study have theoretical value and
practical implications for IMI research.
INDEX TERMS Inclusive medical insurance, intention to participate in insurance, middle-aged and elderly,
trust mechanism.
I. INTRODUCTION
In recent years, livelihood-related topics, such as ‘‘medi-
cal costs,’’ ‘‘pension care,’’ and ‘‘three-child policy,’’ have
become hot topics, resulting in the insurance industry receiv-
ing unprecedented public attention. Due to the increasing
emphasis on health issues among the population, the demand
for insurance services has also begun to rise significantly.
At the same time, the digital transformation of the insurance
industry has become an industry hotspot due to changes in
how consumers access information, along with the develop-
ment of their online transaction habits.
The associate editor coordinating the review of this manuscript and
approving it for publication was Lorenzo Ciani .
Inclusive medical insurance (IMI), which focuses more
on welfare, refers to the insurance provided to the Chinese
consumers under the guidance of national policies adhering to
the dual principles of equal opportunities for all and sustain-
able business development. To further implement the national
policy goal of establishing a multilayered medical security
system and solve the livelihood problem of local people who
typically consider seeing a doctor as ‘‘difficult and expen-
sive,’’ residents are jointly underwritten by some insurance
companies under the guidance of the local medical security
bureau and the overall supervision of the China Banking
and Insurance Regulatory Bureau. This paper focuses on
tailored IMI. Following the ‘‘One city, one policy’’ principle
of the China Banking and Insurance Regulatory Commission,
71398 This work is licensed under a Creative Commons Attribution 4.0 License. For more information, see https://creativecommons.org/licenses/by/4.0/ VOLUME 10, 2022
D. Li et al.: Exploring the Intention of Middle-Aged and Elderly Consumers to Participate in IMI
and combining data on the local economic development level,
medical insurance, and tailor-made pricing, among others, the
launch of inclusive commercial health medical insurance has
the characteristics of low threshold and high protection and
aims to reduce the need for insurance participation. It aims
to resolve the economic burden of high medical expenses for
personnel due to serious illnesses.
According to the ‘‘2021 Insurance Industry Digital Insight
Report,’’ China’s insurance industry has entered a stage of
high-quality development from the previous stage of rapid
development. The analysis shows four main trends in the
development of China’s insurance industry today: (1) the con-
tinued improvement of the macro environment and residents’
gradually increasing awareness regarding active insurance;
(2) the national government’s issuance of relevant policies to
encourage insurance companies to make innovation attempts;
(3) consumers’ increased reliance on online transaction chan-
nels; and (4) the development of insurance as an important
strategy for insurance institutions to face the challenges of
transformation.
Faced with changes in user needs and the rapid develop-
ment of online insurance, many large insurance companies
have chosen to increase their investments in online marketing,
even though the returns are uneven. At present, insurance
companies deal with several online marketing challenges,
including the coexistence of online and offline integration
and separation trends; insurance companies with insufficient
differentiated competitive advantages facing the growing
pains of transformation; and determining whether platform
scenarios [1], customized services [2], and technological
advantages [3]–[5] can compete for important factors in the
market. Therefore, how to deal with technological innovation
and role transformation to form a healthy foundation for the
operation of the industry has become a key issue that requires
further investigation.
For Medicare, middle-aged and older adults typically make
up a larger share of the customer base compared to other age
groups [6]. The ‘‘2021 Insurance Industry Digital Insights
Report’’ revealed that ‘‘change’’ is the biggest factor moti-
vating the former to buy insurance. The changing brows-
ing habits and increased use of electronic devices among
middle-aged and elderly groups have increased their prefer-
ence for browsing forms, while 63% of them prefer to obtain
insurance information in the form of short videos. Most of the
issues come from the online insurance experience. Thus, the
current article aims to focus on the participation of middle-
aged and elderly consumers in IMI and to deeply explore the
influencing factors behind their intention to participate.
According to Mendes-Da-Silva, et al. [7], the abun-
dance and disclosure of economic information play an
important role in the propensity to purchase insurance.
Dragos, et al. [8] divided economic behaviour into gen-
eral financial behavioural variables and insurance-specific
behavioural variables. They confirmed that all variables
have a certain degree of influence on the intention to pur-
chase insurance. Besides sociodemographic characteristics
and economic factors, You, et al. [9] also found that the health
status and health behaviours of the elderly affected the pur-
chase of indemnity private health insurance Innocenti, et al.
[10] showed that past negative health experiences, knowing
someone who suffered from ill health and other personal
experiences significantly affect insurance purchase inten-
tions. Kai, et al. [11] revealed that peer effects (such as con-
formity and comparison), perceived risk and other consumer
behaviour characteristics influence the purchase intention of
travel insurance for the elderly. For middle-aged and elderly
consumers, Cha [12] indicated that chronic diseases and
family income affect their willingness to purchase private
health insurance. Furthermore, Cha [12] confirmed that asset
status has a more significant impact on the late-middle-aged,
while physical and mental health is the key factor for the
older. According to the existing literature, researchers pay
more attention to the influencing factors of behaviour, and
there is less research on the internal mechanisms among
factors. Second, the trust transfer situation is less discussed,
especially the actual mechanism of action for middle-aged
and elderly consumers. To bridge the above gap and effec-
tively explore the mechanisms of different factors affecting
insurance participation intention, we adopted an empirical
approach. We also shed light on the relationship and influence
of factors on behaviour through the questionnaire. Mean-
while, using the structural equation model allowed us to
systematically explore the effect of the relationships among
variables.
Jung, et al. [13] collected data on insurance purchasers
through in-depth interviews and found that premium, time
and autonomy positively affect purchase behaviour through
social network analysis. Zhou [14] conducted a grey correla-
tion analysis using data released by official institutions from
2005 to 2015. The results pointed out that social insurance
expenditure is the most important economic factor affecting
the demand for long-term care insurance, and the influence
of per capita education level and elderly dependency ratio
among non-economic factors are more important. Most of the
existing research on trust and trust transfer also uses regres-
sion models for quantitative research [15]–[18]. However,
this survey target is a new type of medical insurance IMI,
and the subjects are middle-aged and elderly groups. Second,
our research question concerns the influencing factors of the
intention of middle-aged and elderly consumers to participate
in IMI. In addition to exploring what factors affect intention,
we also need to determine the relationship between the factors
and the common mechanism of action. Other methods do not
help to study the overall effect or draw conclusions directly.
For example, the interview method helps to dig and extract
motivation at a deeper level, which is a more suitable method
in the early stages of research and when new problems
arise. Most researchers have relatively abundant research
results with influencing factors; however, the mechanism
of action is relatively unclear. Hence, we used a ques-
tionnaire survey and PLS-SEM. Both methods can effec-
tively and practically help us analyze and solve problems.
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The questionnaire method has the advantages of saving time
and effort, reducing errors and avoiding bias. It collects more
representative, in-depth and real data to help analyze the
relationship between existing phenomena and variables that
have a certain relationship. Questionnaire design can effec-
tively help concretize concepts, and measurable indicators
can verify our hypotheses through quantitative analysis. Due
to the small number of samples and many measurement vari-
ables, we used PLS-SEM. This helps us effectively avoid the
collinearity problem of traditional regression models.
First, based on the trust transfer theory and existing
research, we combine financial trust (customers have beliefs
in the financial-related knowledge, products and talents they
contact [19], [20]), technology trust (customers believe in
the technologies support they are exposed to is reliable [21])
and institutional trust (customers believe that the institution
is honest, trustworthy and competent [22]) as the core model
of the study. That is, to establish a trust mechanism based on
the relationships among the three.
Then, with the background of middle-aged and elderly
people participating in IMI, we set up four potential vari-
ables: (1) the new insurance service concepts (integrity and
effectiveness of insurance services supported by digital tech-
nology [23], [24]), (2) perceived ease of use (the ease that
users feel when using the technology [25]), (3) reputation
(perception of the organizational image in different media
forms [26]) and (4) guarantee mechanism (structural guaran-
tee to safeguard consumers’ rights and interests [27]). We also
studied the influence of four latent variables on trust. Further,
we explored financial trust, institutional trust and intention to
participate (subjective willingness to participate after forming
opinions on IMI services [28]).
This paper conducts an empirical analysis based on the
medical insurance needs of middle-aged and elderly con-
sumers and finds that each variable has a significant impact
on the corresponding trust. Furthermore, there is a transitive
relationship among the three trusts, which in turn affects par-
ticipation intention. On one hand, the research results expand
the applicability of trust transfer theory in the insurance field.
In the existing literature, the single trust study is relatively
general, and there are factors influencing trust transfer, but
the variables affecting initial trust have not been studied [29].
In this study, the three trusts are more specific. According to
the medical insurance concerns of middle-aged and elderly
groups, the trust mechanism built by trust is used to study
the effect of external variables and the influence of trust on
the intention to participate. A more comprehensive expla-
nation of the phenomenon of middle-aged and elderly con-
sumers participating in IMI provides a theoretical explanation
through a complete theoretical framework. On the other hand,
when the middle-aged and elderly groups participate in IMI
and other financial services, it shows a reference for the items
and elements that the middle-aged and elderly groups should
measure. Also, it provides specific practical guidance for
the design, promotion and assurance of IMI for institutions,
governments and other organizations.
The remainder of this study is summarized as follows.
Section 2 reviews the literature on health care delivery and
health care trust, as well as discusses the research status
and gaps in the literature. Section 3 builds a conceptual
model based on the assumptions proposed in this study.
Section 4 provides details on the study design and uses
structural equation modeling to analyze the data. Section 5
discusses the findings, while Section 6 presents the theoret-
ical contributions and managerial implications of this study.
Finally, Section 7 provides the conclusions, study limitations,
and future research directions.
II. LITERATURE REVIEW
A. MEDICAL INSU RANCE SYSTEM
At present, institutions at home and abroad provide different
types of medical security services, and many researchers have
investigated the related conditions of these services [30], [31].
For example, in their research on medical security services in
China, Yang and Hanewald conducted a nationwide survey
of Chinese people aged 45 and above and found that the life
satisfaction of middle-aged and elderly people did not depend
on whether they had any health insurance but varied with
the type of health insurance coverage [32]. They also found
that individuals enrolled in the most favorable government
health insurance plans reported higher life satisfaction. In a
similar study, Zeng et al. studied and explored the impacts of
different types of medical insurance on the medical expenses
of the elderly in China and found that the proportions of the
number of people participating in basic medical insurance for
urban employees, basic medical insurance for urban residents
and rural residents, and those with commercial medical insur-
ance were 10.8%, 8.4%, 72.7%, and 0.9%, respectively [33].
They also found that, above all, establishing a fairer medical
insurance system should be the next step in China’s healthcare
reform.
Wang et al. investigated the relationships among health
insurance, city of residence, and outpatient visits among the
elderly living alone in China and found that those who had
basic medical insurance for urban employees, basic medical
insurance for urban residents, and public medical insurance
could easily make outpatient visits compared to older adults
living alone without health insurance [34]. After controlling
for the number of chronic diseases, only those with public
health insurance were more likely to visit a clinic than those
without insurance. In addition, the elderly living in Shanghai
and Guangzhou were more likely to receive outpatient treat-
ment than those living in Chengdu, while those living in
Dalian and Hohhot were less likely to receive outpatient treat-
ment. According to Wang et al., to promote equitable access
to outpatient visits among the elderly living alone in China,
government policies should strive to reduce the fragmentation
of different medical insurance plans, expand the coverage
of medical insurance for the elderly, provide solutions that
consider the needs of this special group of people, and reduce
the inequality of medical resources and medical insurance
policies among cities.
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B. INFLUENC E FACTORS OF INTENTION
Such inequality has been attributed to six factors at least:
(1) Economy; (2) Health status; (3) Technical support and
safety; (4) External influence (i.e. financial incentives);
(5) Preference; (6) Trust [35]–[38]. Economic factors directly
affect people’s intention and ability to pay in terms of the
economy. In a study on intention to pay, Wang, et al. [35]
investigated the situation of home-based rehabilitation ser-
vices for the elderly in Shanghai and found that only 44%
of the respondents were willing to pay for home-based reha-
bilitation services. The median price they were willing to pay
was 8 Chinese yuan (US $1.20) per visit. Seniors with higher
monthly incomes, at least one partner with a job, and health
insurance were also willing to pay more for the services.
However, older adults showed a lower intention to pay for
such services. The authors found that economic status and
health status are important factors affecting the intention to
pay. Although their study did not examine inclusive health
insurance, the home rehabilitation services it investigated had
many correlations with inclusive health insurance. Thus, their
results can be used as a reference for the present study.
In addition to economic and health status, technology
and external influences (i.e., financial benefits provided to
customers) also influence the participation of middle-aged
and older consumers in health insurance. For example,
Soliño-Fernandez, et al. [36] conducted a study on people’s
intention to adopt wearable device-based health insurance
plans in the US and found that, on average, 69.5% of the
respondents were willing to avail of such insurance plans.
In health insurance use cases, 77.8% of the respondents
expressed concerns about issues, such as financial benefits,
data privacy, and technical accuracy. The researchers argued
that two-thirds of Americans were willing to adopt a wear-
able device-based health insurance health plan with sufficient
economic, data privacy, and technological conditions [36].
In another study, [37] explored the knowledge, perception,
intention to pay, and preferences of health insurance among
potential health insurance beneficiaries; they concluded that
health insurance beneficiaries tend to pay relatively low levels
of monthly health insurance costs rather than co-sharing.
Finally, people’ s trust is another important factor influenc-
ing their intention to participate in inclusive health insurance.
Related to this, Shao, et al. [38] explored, identified, and
studied various trust targets and their transfer mechanisms in
blockchain-based medical mutual assistance platforms. They
found that three types of trust (technical trust, member trust,
and platform trust) played a significant role in promoting
users’ behavioral intentions toward online medical platforms.
Furthermore, they discovered that the three trust objectives
were formulated through different platform mechanisms.
C. TRUST TRANSFER THEORY
In marketing, trust is often the result of people’s rationality.
It is a kind of confidence that gives each other reliability and
integrity. As emotional sustenance, trust is used to describe
and maintain the relationship among people, thus deriving
a series of actions [39]. Sociologists define trust as social
capital [40]. In the context of the social environment, the trust
formed by interaction leads to political, economic, cultural,
and other activities. The success of any activity is inseparable
from trust, especially in the transaction process, where trust
affects the final result through commitment [41]. The impor-
tance of trust attracts more and more researchers in different
fields. Some researchers take the trust mechanism as the core.
They study how to promote the establishment of trust and the
role of building the trust mechanism. For example, Zucker
[27] studied the impact on trust from the three dimensions
of reputation, social similarity, and legal system. For another
example, Lars et al. applied the relationship between trust and
reputation to network security and called the network security
protection measures under the trust mechanism soft Security
[42]. Based on trust transfer theory, other researchers study
the relationship among various trusts, trust transfer, and trust
aggregation. Trust transfer is the movement of a person’s trust
in an entity to another entity, both a trust mechanism and a
trust transfer [43], [44]. For example, if you trust someone
who works for you, you will naturally develop goodwill
and trust towards their organization. According to the trust
transfer theory, the subject will trust the target when the trust
object has a good connection with another object [43]. In the
social media brand community, consumers’ perceived value
will form a kind of trust for them. They will trust the brand
and social media through communication and cognition and
then form a good e-WOM and promote purchase intention
[44]. For time banking, Leung et al. studied the rapid trust
of offline trust and online trust in non-governmental orga-
nizations and the subsequent prosocial behaviour after brief
exposure [20]. On the other hand, Gong et al. used perception
ability as a communication link to study the trust transfer
from trust source (network payment) to trust target (mobile
payment) [45]. Similarly, Zhao, et al. [46] conducted research
on retailer trust-promotion-brand trust in C2C transactions.
Trust transfer theory is widely used in various fields
and application scenarios with broad applicability and high
interpretability. The content of this research is in finance,
so we developed the theory from three dimensions: finance,
technology, and institution. Most of the existing literature
discusses trust from a single dimension, but there are also
cross-studies on trust. van der Cruijsen, et al. [47] used con-
sumer data spanning 14 years and self-assessment methods
to find that people with high financial literacy are more
likely to generate financial trust, which can also be trans-
ferred to institutional trust. Technological trust refers to the
dependence and confidence of computer technology, which
is constrained by rules and can make corresponding response
measures [48]. The trust generated by the interaction between
technology and the outside can then have an impact on inter-
personal trust [49], business trust [50], and platform trust
[51] Harrison McKnight, et al. [22] took the website as an
institution, studied the website-supplier trust mechanism, and
further explored the possible actions after consumers trust
institutions and providers. The three types of trust in the IMI
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D. Li et al.: Exploring the Intention of Middle-Aged and Elderly Consumers to Participate in IMI
market have different definitions, cognitions, and connection
methods. Therefore, this study adopts the trust transfer theory
to conduct in-depth research to provide theoretical references
for the design and marketing of IMI.
D. IMI RE LATED WORK
IMI is a combination of social insurance and commercial
insurance, and it is commercial insurance that improves med-
ical protection on basic medical insurance. The government’s
intervention makes the price of IMI generally lower than
that of ordinary commercial insurance, with the character-
istics of inclusive and public welfare. All kinds of IMIs on
the market are positioned to reimburse expenses outside the
scope of medical insurance, which can reduce the medical
burden of many ordinary families. Compared with millions
of medical insurance, IMI is supported by the government,
which can win more trust from the public, and has the
advantages of reimbursement for most pre-existing condi-
tions, low insurance conditions, and a high possibility of
renewal. Correspondingly, IMI also has the disadvantages of
less protection scope and less reimbursement ratio. However,
the group of middle-aged and elderly consumers in particu-
lar. They are often denied high-value insurance because of
age, health, and other problems. When facing major medical
diseases, they still need to pay a considerable part of the cost.
In this way, IMI with high reliability, low price, and complete
Security is the best choice for the middle-aged and elderly
to choose additional medical insurance. In China, the launch
of IMI in many places will cause citizens to snap up and
participate in IMI has become a trend. However, due to a lack
of relevant financial knowledge or various concerns, fewer
middle-aged and elderly consumers participate in IMI.
IMI is characteristic insurance proposed by China to
improve the medical insurance system. Most of the exist-
ing studies are about the top-level design of its theoretical
development [52]–[54]. At present, we found only one empir-
ical study on IMI. Liu, et al. [55] surveyed IMI in rural
Zhejiang Province. The study found that IMI reduced the
risk of poverty due to disease, but the coverage rate was
not high. They also found that price, cognition, and income
factors significantly affected rural residents’ participation.
The factors affecting rural residents’ satisfaction with IMI
are, from high to low, benefiting the people, convenience, and
comprehensive Security.
Although the medical security systems of other countries
are different, there are commercial medical insurance studies
based on inclusive policies or social inclusivity. Countries
that implement ‘‘Medicare for All’’ using commercial medi-
cal insurance as a supplement. Through policy incentives and
government service plans, the commercial insurance compa-
nies undertake and manage part of the public medical security
work [54]. In this regard, most researchers studied commer-
cial insurance from the perspective of inclusive technology
and service, providing a reference for the strategic develop-
ment of insurance companies [56], [57]. In contrast, countries
that have not implemented ‘‘Medicare for All’’, such as the
United States, mainly rely on commercial medical insurance
to achieve inclusive benefits through supplementary med-
ical insurance plans [54]. In the United States, Medicare
Advantage (MA) is a kind of inclusive commercial insur-
ance realized by the federal government subsidizing com-
mercial insurance companies. Many studies have compared
MA with traditional medicare and found that although MA
has shortcomings, it has relative advantages in most nursing
quality indicators [58]–[60]. MA moderates Fee-For-Service
spending, and the number of participants increases [61].
Park, et al. [62] further divided and compared MA users and
found that the rapid increase of MA users is due to the influx
of new entrants of the elderly rather than the existing ones.
In another study, Korenman, et al. [63] found that Health
Inclusive Poverty Measures, including medical insurance, can
effectively reduce the poverty rate of the elderly and provide
more accurate guidance for social policies.
Most of these existing studies focus on people’s participa-
tion in various forms of medical services without delving into
which factors determine their intention to participate. Thus,
the current article aims to focus on this point by the current
research status and propose hypotheses on the influencing
factors of the intention of middle-aged and elderly groups
to participate in IMI. Furthermore, this work will verify and
summarize its hypotheses through survey data and explore the
factors influencing middle-aged and older people’s intention
to participate in IMI.
III. THEORETICAL FRAMEWORK
A. CONCEPTUAL BACKGROUND
Trust transfer theory distinguishes trust and judges the rela-
tionship among trusts, which is more complex and complete
than the single trust research [39], [43]. The theory has been
applied in various consumer behaviour studies, and it can
better explain consumers’ behaviours and intentions [64].
These previous studies have shown their value in many areas
and have inspired us to use them in this study. Therefore, this
study sets three potential variables of trust and integrates the
existing research on the relationship between financial trust,
technical trust, and institutional trust [20], [47], [51] to form
a trust transfer mechanism to explore further the impact on
middle-aged and elderly consumers’ participation intention.
B. RESEARCH MODEL AN D HYPOTHESIS
In this research, the concept of ‘‘new insurance service’’ is
defined as a service in which the entire process of insurance
service can be truly effective from beginning to end. This
process is completed under the support of digital pipeline
applications, especially in terms of communication and con-
tact in the service process, as well as a streamlined insurance
underwriting and claim settlement process [23], [24], [65],
[66]. Studies have shown that the effectiveness of health care
services and community care services can improve frailty,
loneliness, and quality of life in older adults living alone
in the community, and that interventions have a positive
impact on their quality of life [67]. The positive effects of
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service effectiveness can increase satisfaction and enhance
trust[68]. When making a decision, individuals should not
only be able to analyze the risks and benefits of insurance
products, but must also have financial trust, meaning they
trust and identify with the financial information, data, and
contacts they have obtained. The new service concept lists
the need for financial products, such as insurance, from the
perspective of the insured. This is in line with the value
concept of the market economy. Under this influence, middle-
aged and elderly consumers have a good impression of med-
ical insurance services and show improved financial trust
to a certain extent. Therefore, the following hypothesis is
proposed:
H1: The new concept of insurance service will increase the
financial trust of middle-aged and elderly consumers.
Perceived ease of use refers to the ease of using technology.
Today, many insurance service products and technologies,
such as online services and electronic signatures, are inte-
grated to create new products. The perception of technology
during contact has an impact on behavioral control. In the
technology acceptance model (TAM) literature, it is generally
recognized that positive relationships exist among perceived
ease of use, attitudes, and behavioral intentions [69], [70].
However, a positive attitude is inseparable from an increase
in trust. Hansen et al. proved that trust promotion is related
to perceived ease of use [71]. Therefore, we propose the
following hypothesis:
H2: Perceived ease of use has a positive impact on the
technology trust of middle-aged and elderly consumers.
The reputation of an institution is defined as the cumulative
sum of different brand image perceptions presented in various
forms of media and are collected by stakeholders through
different tools over time [72]. A good reputation can ensure a
sustainable competitive advantage, implicitly creating a good
impression on government and insurance companies [73],
[74]. At the same time, the guarantee mechanism enables
sellers to guarantee their ability to reduce their customers’
shopping risks, thus making it an effective marketing tool
for promoting sales. Especially in online transactions, many
scholars have suggested that online sellers should follow
the principle of ‘‘no reason return’’ and have expanded
research on online returns to multidimensional factors [75].
On the basis of their quality commitment, many institu-
tions have also adopted a combination of service quality,
after-sales, and compensation guarantees to reduce cus-
tomers’ perceived risks and enhance customers’ confidence
in their products. Therefore, the following hypotheses are
proposed:
H3: Reputation positively affects the institutional trust of
middle-aged and elderly consumers.
H4: The security mechanism positively affects the institu-
tional trust of middle-aged and elderly consumers.
Given that the essence of financial transactions is the
exchange of money and promises, the trustworthiness of
promises is particularly important, and mutual trust is the
key factor in the success of a transaction [70]. Financial
trust refers to the degree to which people believe in finan-
cial knowledge, products, and talent. The IMI launched by
the Chinese government in conjunction with insurance com-
panies still has the essence of a commercial product, and
the purchase of commercial insurance has been shown to
be affected by the level of household income, the level of
regional financial development, and other factors [76]–[79].
On the one hand, Hasting et al. argued that consumers’ lack
of financial knowledge can induce them to invest less or not to
invest at all [80]. On the other hand, Christeils suggested that
increased financial literacy can also increase the likelihood of
consumers’ participation in risky investments [81].
Trust is also influenced by the level of trustworthiness
presented by a financial institution. Gatzert et al. argued
that the soundness of an insurance company’s financial feed-
back mechanism is an important factor in increasing its
market share, which is a reflection of its economic strength
and enhances consumers’ perception of the insurance insti-
tution [82]. In addition, IMI is jointly launched by the
government and insurance companies; in the eyes of our
nationals, the government provides a strong backing for the
people, who, in turn, are willing to trust insurance products
(and the insurance companies) because of their trust in the
government. This enhances their willingness to participate in
insurance. Based on this information, the following hypothe-
ses are proposed:
H5: Financial trust positively affects the intention of
middle-aged and elderly consumers to participate in IMI.
H6: Institutional trust positively affects the intention of
middle-aged and elderly consumers to participate in IMI.
In this study, technological trust refers to the belief that
the insured can rely on a predictable technological operation
process to promote the success of the transaction generated by
the direct interaction between the insured and the institution
[83]. The efficiency-enhancing technologies used by insureds
to make transaction decisions help them better build financial
trust. Good technical trust can play a role in promoting the
success of transactions and increasing the insureds’ intention
to pay. Related to this, the foundation of technology comes
from institutions that conduct transactions with consumers;
thus, the technical trust of the insureds can be transformed
into institutional trust [84]. At the same time, the nature of the
insurance industry makes financial trust extremely important
in transactions involving insurance services, and the institu-
tions involved in the transactions must ensure financial trust
in the process. Thus, the insureds’ financial trust will also be
transmitted to the institution. Therefore, this study proposes
the following hypotheses:
H7: Technical trust positively affects the financial trust of
middle-aged and elderly consumers.
H8: Technical trust positively affects the institutional trust
of middle-aged and elderly consumers.
H9: Financial trust positively affects the institutional trust
of middle-aged and elderly consumers.
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FIGURE 1. Research framework.
TABLE 1. IMI participation intention constructs.
IV. RESEARCH DESIGN AND RESULT
A. RESEARCH SETTI NG AND DATA SOURCE
Based on the existing literature, this research used and
adjusted the survey tools and designed a 5-point Likert scale
to construct the measurement tool. We divided the ques-
tionnaire into three parts. First, we clarified the background
and significance of the research purpose. Second, we anony-
mously collect basic information such as gender, age and edu-
cation level. Then, a scale (as shown in Appendix 1) designed
based on existing literature was used to measure the eight
constructs. This study focused on middle-aged and elderly
consumers, so people over the age of 40 were identified as the
population sample. Also, we set up a pre-screening mecha-
nism, and the sampling frame is limited to the individuals who
have participated in IMI. The survey started with ‘Have you
ever been covered by universal health insurance?’ to identify
respondents.
The questionnaire was carried out using an electronic ques-
tionnaire with simple random sampling. This is for personal
safety for COVID-19, but also to get a larger, more represen-
tative sample. First, we conducted a pilot test. We recruited
20 volunteers who met the requirements to fill out the ques-
tionnaire. Then, according to the 20 valid questionnaires
collected and the problems encountered in the pilot test, the
research team revised and improved the questionnaire and
invited experts to review it. After that, we distributed the ques-
tionnaire online in the form of links and QR codes. Within the
scope of the survey fee, we tried to increase the attractiveness
of the survey through publicity. We tried to increase the
sample size and actively tracked the questionnaire recovery.
Then, excluding invalid questionnaires, such as no answer,
incompleteness, wrong filing, short answer time, too concen-
trated options, etc., a total of 247 valid questionnaires were
collected. TABLE 2 presents the demographic characteristics
of the survey sample. As can be seen, there is no significant
difference in the overall characteristics of the sample.
We informed the participants in detail about the research
before it began, including, but not limited to, the research
purpose, methods and process. We also stressed the unpaid
and voluntary nature of participating in the research study,
so the participants would have the right to refuse to participate
or withdraw from participating at any time. We only began
data collection after obtaining the consent of the participants.
The sample size of this study is small, and there are
many variables and multiple correlations. Thus, partial least
squares structural equation modeling (PLS-SEM) was used.
PLS-SEM is a multi-to-multiple linear regression model-
ing method that considers measurement error and integrates
the advantages of a variety of traditional multivariate lin-
ear regressions. First, we evaluated the measurement model,
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TABLE 2. Demographic profile of respondents, n=247.
TABLE 3. Descriptive statistics for the constructs.
including convergence reliability and discriminant validity.
We then evaluated the structural model by checking the
strength of individual paths and testing the hypotheses.
B. MEASUREM ENT MODEL ANALYSIS
This research used the PLS bootstrapping procedure and
generated composite reliability (CR), Cronbach’s alpha (CA)
and average variance extracted (AVE) for each construct,
as shown in TABLE 3. We used two procedures to assess
convergent validity. The results show that, first, the CA and
CR for all reflective constructs exceed 0.8, and all AVE
values are above 0.7 (reference thresholds). Second, the factor
loadings of indicators with their respective constructs have
loadings exceeding 0.7. These indicate that the measurement
model of this study has a high level of consistency validity.
Next, we tested discriminant validity. The results show that,
first, the AVE for each construct is more than 0.8 (as seen
in TABLE 3), and all values in a diagonal position are larger
than those in the independent columns (as seen in TABLE 4).
Second, the factor loadings of any index are greater than the
cross-loadings of the index and the other constructs, as shown
in TABLE 5. Therefore, the results indicate good discrimina-
tive validity.
C. STRUCTURAL MODEL ANALYSIS
In this research, the t-value significance test of the pathway
coefficient was conducted. The original sample number was
247, and the maximum iteration number was 5000. Eventu-
ally, we obtained the path coefficient, significance results,
and R2of each internal variable. As shown in Fig. 2,
p≤0.05 supports each of the nine hypothesis paths,
and seven hypotheses (H1–H6and H8) are significant at
the 0.001 level. In the theoretical model interpretation, the
R2values of financial trust, technological trust, institutional
trust, and insurance intention are 0.402, 0.573, 0.628, and
0.608, respectively, thus proving that the research model has
sufficient explanatory power.
V. DISCUSSION
According to the results, the new concept of insurance service
increases the financial trust of middle-aged and elderly con-
sumers. The entire process of providing insurance services
starts from consultant channels up to service personnel and
ends with insurance products. The effective performance of
the overall service increases the confidence of middle-aged
and elderly consumers in IMI. In addition, service effective-
ness builds and improves consumers’ trust in insurance staff.
In the entire process of providing effective insurance services,
service personnel are bound to take intervention measures,
address regular inquiries, and provide monitoring and care.
Related to these, performing appropriate interventions can
lead to the provision of tailored emotional support for middle-
aged and elderly consumers behind cold products [67]. In this
way, satisfactory insurance services can increase their trust in
financial knowledge, financial products, and financial talents.
As ..Mendes-Da-Silva, et al. [7] found, in the context of risk
and uncertainty, a lack of economic information and insuffi-
cient information disclosure increase the insurance costs of
consumers, while reducing the intention to buy insurance.
Supported by digital technology, the appropriate disclosure of
financial information and popularization of financial knowl-
edge can promote the financial literacy of the middle-aged
and elderly and help them understand the content and role of
IMI with less time and money cost. They will also produce
intangible recognition of IMI products and services. Fur-
thermore, Shim, et al. [19] revealed that subjective financial
knowledge is directly proportional to financial trust. The new
concept of IMI service in this research is a new type of
subjective financial knowledge. As a digital financial inclu-
sion product, IMI operates at a lower cost and can reduce
the pressure of poverty and promote economic growth. The
financial literacy of middle-aged and elderly consumers has
increased due to the knowledge popularization of IMI and
other environmental influences, which in turn will also pro-
mote financial trust [47].
According to the research results, perceived ease of use
can positively affect technological trust. This is consistent
with the results of [69], Benamati, et al. [70] and Lin and
Lu [85]. In contrast, this study is based on middle-aged and
elderly consumers choosing insurance products, which can
effectively supplement the impact of technical factors on
the insurance trust of middle-aged and elderly consumers.
For the new concept of insurance services, middle-aged and
elderly consumers need to deal with technology in the process
of searching for product information, using the platform of
financial institutions, etc. The generation and purchase of
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TABLE 4. Correlations among constructs and the square root of the AVE.
TABLE 5. Factor loadings and cross loadings.
digital products cannot be separated from technology. In this
way, the technological experience of middle-aged people and
the elderly in the IMI participation process affects trust in
technology. In choosing insurance products, middle-aged and
elderly consumers may face problems related to the so-called
‘‘digital divide,’’ such as information search confusion and
other technical problems. Using reasonable technology to
design products, along with a complete service process, can
effectively help solve the abovementioned problems [65].
While technical risks are unavoidable, people usually mini-
mize risk by using security protocols or functions. Leaving
some technologies to consumer control, maintaining a cer-
tain degree of transparency, and providing a higher level
of digitalization can improve the customer experience and
enhance trust in technology.
The results of the study also indicate that reputation and
security mechanisms positively affect the institutional trust
of middle-aged and elderly consumers. At a time when they
are still unfamiliar with IMI or have to deal with institu-
tions related to IMI for the first time, the reputation of the
institution often becomes the most valuable evaluation cri-
terion. At the same time, an organization’s reputation often
comes from other third-party organizations or personnel,
which have a higher reference value than the organization’s
publicity [73], [86]. Similar to this conclusion, Filipiak [87]
pointed out that the internet, broadcast and other media
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FIGURE 2. PLS-SEM analysis results.
information resources (attain a good reputation) can make
up for the distance perception among individuals and orga-
nizations, thus enhancing institutional trust. According to
Rojas, et al. [88], previous transaction value and current eval-
uation influence reputation. It is directly transferred between
two subjects or through a third-party subject. A reputa-
tion, such as online feedback mechanisms and traditional
word-of-mouth networks, can help consumers build trust and
have a far-reaching impact on product development, quality
assurance and customer relationships [89]. A good product
or service experience stimulates the spread and diffusion of a
reputation, which in turn helps to quickly build and increase
institutional trust.
Our results show that security mechanisms positively affect
institutional trust. Kai, et al. [11] showed that perceived risk
promotes elderly consumers’ intention to purchase insurance
and that it can be controlled. According to several studies
[27], [75], [90], guarantee mechanisms reduce consumers’
perceived risks and promote trust. Pavlou and Gefen [91]
identified that IT-enabled guarantee institutional mechanisms
promote customer’s perceived effectiveness, such as per-
sonal information protection and service feedback atten-
tion, thereby helping to build buyer’s trust in the seller’s
community. However, we directly studied the relationship
between safety mechanisms and institutional trust and found
that both mechanisms have a direct and significant impact.
The guarantee mechanism shows the content and method
of safeguarding the interests of consumers in the form of a
commitment to increase consumers’ confidence in the orga-
nization. The insurance industry has certain risks, because
there is always a gap between the two sides of the transaction.
Furthermore, the risks involved in online transactions are
higher than in traditional offline processes. Related to this,
the guarantee mechanism helps minimize the risks in such
transactions, reduce customers’ worries, and increase their
trust in institutions.
Many studies have shown that trust has a significant pos-
itive relationship with behavioural intention [15], [18], [22],
[92]. Based on the data analysis, we conclude that both finan-
cial trust and institutional trust positively influence the inten-
tion of middle-aged and elderly consumers. These results
are like Shim, et al. [19]. While their research background
is young people facing the economic crisis, we point out
that two forms of trust in middle-aged and elderly groups
influence IMI participation intention. Alternatively, Xu [93]
studied the positive correlation between trust and inclusive
financial participation in a global context. Our research sub-
jects and objects are relatively small, so our research conclu-
sion can be used as a branch to verify Xu’s conclusion. As a
key factor, trust has a more significant impact on participation
behaviour than risk aversion and ambiguity aversion [94].
The higher the trust in financial products and institutions, the
higher the willingness to conduct financial transactions with
financial institutions. When trust is high enough, customers
participate in economic behaviours [94], [95]. Those with
extensive financial knowledge and information sources are
more likely to accurately assess the expected returns of invest-
ment projects and are, therefore, more willing to make bold
investments [33]. With sufficient financial knowledge and
data information, their trust in IMI increases substantially,
thus promoting their intention to participate. As mentioned
previously, IMI was introduced by the government in con-
junction with insurance companies. Hence, consumers are
likely to transfer their trust in the government to the insurance
agency. This allows the latter to gain transfer trust, which then
enhances consumers’ intention to purchase.
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The results further reveal that technological trust increases
financial trust and institutional trust among middle-aged and
elderly consumers. If they can intuitively query their account
information and some details of the transaction informa-
tion they could participate in or have already participated
in through the transaction system, then they can have a
clearer understanding of the financial information involved in
the transaction, thereby increasing their financial trust [96].
The behaviour of middle-aged and elderly consumers in
information search, online interaction, online payment and
other links needs certain technical support. Safe and reli-
able technology can reduce the external risks perceived
by consumers and enrich consumers’ financial knowledge
reserves through high-quality information [50]. Meanwhile,
it provides convenience for communication and interaction
between consumers and relevant personnel, thereby increas-
ing overall confidence in the product and generating trust
in the transaction. As studied by Shao, et al. [84], when
consumers believe that institutions have strong technical
capabilities and can effectively provide services, their trust
in institutions will also increase accordingly. Technological
trust also plays an important role in these consumer groups’
willingness to participate in inclusive insurance transactions,
and the systems used in the transactions originate from the
institutions involved in such processes. The pros and cons of
the system depend on the technical capability of the institu-
tion to which it belongs, and its technical capability can also
reflect many aspects of the institution itself.
Finally, our results reveal that financial trust increases
institutional trust among middle-aged and older consumers.
This conclusion is like van der Cruijsen, et al. [47], who found
that consumers with financial knowledge are likelier to trust
institutions. In our study, the composition of financial trust—
knowledge, talent and products—are all participated in or
even guided by institutions. The confidence and satisfaction
of the middle-aged and elderly in finance will enhance the
credibility of financial institutions. It is also worth noting
that technical trust affects minor aspects of transactions, but
financial trust undoubtedly affects the core aspects of such
transactions. Hence, middle-aged and elderly consumers can
develop financial trust in the process of understanding the
transaction information related to inclusive insurance, and the
institutions that conduct transactions are the ones that can
ensure financial trust.
The transfer of trust demonstrates the applicability of trust
transfer theory in the insurance industry. Nielsen and Krukow
[97] took trust in the reputation system as the research subject
and found that trust could be transferred from one behavioural
environment to another under the effect of the correlation
of events. In the process of using technology, middle-aged
and elderly groups contact IMI institutions to learn about
the financial information of the product and to communicate
with financial personnel. Trust also shifts from technology
to finance and institutions along with behaviour. According
to Rojas, et al. [88], trust transfer often occurs based on
exchange value, reputation and dependencies. In the context
of IMI, the four latent variables that affect trust are interde-
pendent. The new service concept is based on the demand for
digital technology, and the design and use of technology relies
on the needs of middle-aged and elderly consumers for IMI
services. Technology supports the development and main-
tenance of an organization’s reputation systems and safety.
Instead, reputation and guarantee mechanisms stimulate the
development and innovation of age-appropriate technologies.
The two are also associated with the new service concept, and
there is mutual influence between the two. This inextricable
correlation makes the transmission of trust more solid and
collectively affects behaviour intention.
VI. IMPLICATIONS
A. THEORETICAL IM PLICATIONS
This research provides several theoretical contributions. First,
although there is a great deal of literature on the middle-
aged and elderly pension problem, there is a lack of research
on the intention of these groups against the background of
IMI in China. Apart from accumulating a certain amount
of wealth due to their experience and ability, individuals in
these consumer groups have formed relatively fixed patterns
of cognition of things and themselves. Thus, the composition
of their trust model is different from that of individuals in
younger age groups. For example, in the context of the digital
pipeline, there is a gap between technical design and the
digital divide, as well as the improvement of institutional
reputation and guarantee mechanisms.
Secondly, this paper explores the joint mechanism of mul-
tiple factors by supplementing the theory of trust transfer.
Our research models better explain the various motivations
that influence participation intention. Moreover, we empha-
size trust transfer and establish a multi-level and mutually
affecting trust model in the form of multiple single chains.
It aims to analyze the mechanism better and more effectively
behind behaviours and explain the phenomenon of middle-
aged and elderly consumers participating in IMI, especially
when they have needs and ideas.
Thirdly, the trust transfer theory is extended to expand
its application in the insurance field. This paper reveals the
mediating role of three trust goals between initial latent vari-
ables and participation intention. We also find that technical
trust indirectly increases trust in institutions through financial
trust, and financial trust indirectly enhances participation
intention through trust in institutions.
Fourth, we study technological trust as a fundamental part
of the core. Trust is an expanded asset. In this study, the
results of our trust mechanism model show that technology is
a good tool. The transfer relationships among the three kinds
of trust are also significant and have a positive effect on the
intention of middle-aged and elderly consumers to participate
in insurance
B. PRACTICAL IMPLICATIONS
For middle-aged and elderly consumers, the modern era
is becoming increasingly dependent on digital intelligence.
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Furthermore, the center of power is shifting to a younger
generation, whose pursuit of value involves a new set of
problems. For example, nowadays, young adults face the dual
dilemma of supporting their parents and raising their children.
The participation of middle-aged and elderly consumers in
universal medical insurance can help them cope with the
economic crisis associated with health problems. On the one
hand, this can reduce the economic pressure of maintaining
physical health and lessen the burden on their children. On the
other hand, this allows them to realize their value and pursue
spiritual freedom based on physical health. In addition to
the constraints of objective conditions, personal subjective
factors will also affect the establishment and maintenance of
trust. Therefore, the conclusion also indirectly indicates that
middle-aged and elderly groups improve their self-efficacy,
especially those who do not know IMI, hesitate, or are at a
loss. After learning about IMI, they can choose how to better
participate in IMI. For example, rationally choose the finan-
cial institutions and platforms according to their situation.
On their own, they can learn basic financial knowledge and
necessary technical skills to improve their cultural literacy
and e-health literacy, to identify and judge the suitability
and rationality of IMI services quickly and effectively. When
selecting the service organization and platform, they should
investigate the reputation system and guarantee mechanism
by the internet, media, and descriptions of people around
them. All of these can serve as the measure of whether to
participate in the service.
For financial institutions, the conclusion reveals that
the new service concept can increase the financial trust
of the middle-aged and elderly, which, in turn, positively
affects their intention to participate in insurance. In this
regard, in the face of a product-oriented service mode,
financial institutions should consider the social customer
experience that is demand-oriented, adopt hybrid consult-
ing channels, strengthen the popularization and guidance of
financial knowledge, and use reasonable intervention modes
to increase the financial trust of middle-aged and elderly
consumers. Technically speaking, institutions can consider
simple interface designs, information search guidance, cus-
tomer service robots, and other methods. The implementation
of these changes should focus on ensuring the practicability
of technology and the risk management of technical safety,
while increasing the perceived ease of use of technology
among the target consumer groups. In functional design and
terminology guidance, take suitable for aging design into
account to help middle-aged and elderly groups understand.
In addition, institutions should pay attention to their rep-
utation, win public praise through practical and inclusive
quality services, and promote and interact reasonably in the
media and the internet to spread their influence. Furthermore,
improve the guaranteed mechanism by the law, appropri-
ately increase reasonable compensation, after-sales, and other
mechanisms to increase the added value of services, and
implement systems to standardize the order of the insurance
service industry. The most important thing is to pay attention
to the feedback mechanism, continuously improve its short-
comings through the reflection of customers and media, and
realize closed-loop management of technology, service, rep-
utation, and guarantee mechanism.
The government should design and improve relevant poli-
cies and regulations to protect the interests of consumers
when participating in IMI. Besides, the government should
monitor the financial institutions’ compliance, maintain order
in the industry, and maintain the reputation of institutions.
However, the current IMI with inclusive nature is limited, and
the middle-aged and elderly consumers participate in various
traditional insurances more, and they do not know much about
IMI. Therefore, the government can design and appropriately
launch a more significant number of IMI products under the
circumstances of financial permission and in combination
with local conditions. In addition, the government can publi-
cize and guide the financial trust of middle-aged and elderly
consumers in IMI through official media publicity, external
incentives, and other means.
Based on the discovery of trust transfer, enterprises, organi-
zations, and governments should integrate from the perspec-
tives of technology and finance to better promote institutional
trust. Following high standards better promote participation
in IMI behaviour in a peaceful state. When formulating rele-
vant terms and conditions, marketing personnel of enterprises
and organizations should pay more attention to simplicity
and ease. When communicating with middle-aged and elderly
consumers, they need to be patient and professional and
provide guidance in using technology. Good product and the
personal image will positively affect the corporate image,
thus promoting institutional trust. The government can unify
the basic standards for technological transformation suitable
for aging to encourage the rationality and innovation of finan-
cial products. Moreover, guide the insurance industry through
institutional norms, and supervise financial institutions.
VII. LIMITATIONS AND FUTURE RESEARCH
This research also has limitations, and future research can
be improved and innovated accordingly. First, the number
of recovered samples is small. Furthermore, the question-
naire options are affected by the participants’ subjective will.
Future studies could thus expand the sample size, conduct
surveys in different regions, and examine the reliability of
models among various age groups, such as Generation Z
and Millennials. Second, the data used in this study are
cross-sectional data. Thus, future research can adopt a ver-
tical survey method to further predict future trends through
annual research data obtained over the years. Finally, this
study explored only the overall IMI. Detailed research can
be conducted in the future according to the classification of
insurance types and compensation standards.
VIII. CONCLUSION
Insurance is an effective means of pre-controlling risks and
ensuring proper risk management. With the impact of emerg-
ing technologies, IMI has been offered as a new insurance
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product that combines social and commercial insurance.
Related to this, the current study concretizes the trust that
affects consumers’ intention to participate in insurance and
aims to explore the internal relationship between consumers’
trust and their intention to participate in IMI. The results show
that the new service concept supported by the digital pipeline
can increase the financial trust of the middle-aged and elderly.
Furthermore, technical trust is positively affected by per-
ceived ease of use, and the reputation and security mechanism
of financial institutions also significantly affect the trust of
these consumer groups. In addition, the three types of trust are
independent and mutually influential. In particular, technical
trust positively affects financial trust and institutional trust.
At the same time, financial trust can promote institutional
trust, and both of them can positively increase middle-
aged and elderly consumers’ intention to participate in
insurance.
APPENDIX
ACKNOWLEDGMENT
Yangyan Shi acknowledged that the grant for research on the
supply of market-oriented elderly care services with involve-
ments of financial institutions’ was supported by funding
from the Academy of the Social Sciences in Australia.
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DAN LI was born in Zhejiang, China, in 1999.
She received the B.A. degree from Wenzhou Uni-
versity. She is currently pursuing the M.A. degree
with the School of Management, Zhejiang Uni-
versity of Technology. She has worked as an
Intern with the Baggage Inquiry Office at Air
China, in summer 2019. From 2019 to 2020,
she participated in the scientific research project
‘‘Health diagnosis and early warning of civil avi-
ation aircraft based on artificial intelligence.’’
Her research interests include business data analysis, consumer behavior,
e-commerce, and information service. She has won scholarships for four
consecutive years and graduated with ‘‘excellent thesis’’ and ‘‘outstanding
graduate honors,’’ in 2021.
JIE LV was born in Zhejiang, China, in 1998.
She received the bachelor’s degree in management
from the School of Management, Qingdao Uni-
versity of Technology. She is currently pursuing
the M.A. degree with the Zhejiang University of
Technology. Her research interests mainly include
e-commerce, virtual character marketing, and con-
sumer behavior. She once won the second prize in
the National Mathematics Competition for college
students. She has obtained the Honorary Title of an
Excellent Teaching Assistant in half a year’s postgraduate teaching assistant
work. In her spare time, she has been teaching part-time in educational
institutions, passing on knowledge to others while getting a good education
herself.
LIANGCHEN JING was born in Gansu, China,
in 1998. He received the B.E. degree from the
School of Food Science and Engineering, Zhejiang
University of Technology. His research interests
include logistics engineering and management.
As a member of the team, he participated in the
‘‘The canal cup’’ College Students Extracurricular
Academic Science and Technology Works Com-
petition of Zhejiang University of Technology, in
2019 and 2021, and won the first prize of the team,
in 2019. He worked as an Intern at Nongfu Spring Company Ltd., and
Tingyi Holding Company Ltd., in 2019. He also took an internship with the
Packaging Department and the Laboratory Department, Zhejiang Liziyuan
Food Company Ltd., in 2020.
CONG CAO (Member, IEEE) received the
bachelor’s degree in computer science from
the University of Wollongong, in 2010, the
dual master’s degree in networking and busi-
ness information systems from the University of
Western Sydney and the University of Sydney, in
2011 and 2013, respectively, and the Ph.D. degree
from the University of Wollongong, in 2018. He is
engaged in the research of e-commerce informa-
tion systems, operation management, trust evalua-
tion and management, and user behavior analysis as an Associate Professor
with the School of Management, Zhejiang University of Technology, China.
In December 2018, he was selected for inclusion in the 2018 Spring Sunshine
Plan by the Chinese Ministry of Education and given funding. The project
has also been praised by the Chinese Ministry of Education and the Chinese
Ministry of Science and Technology, and it has attracted wide attention from
several provinces and enterprises.
YANGYAN SHI received the Ph.D. degree in oper-
ations and supply chain management from The
University of Auckland, New Zealand, in 2013.
He is currently an Associate Professor with the
Department of Management, Macquarie Univer-
sity. He has several years of industrial experi-
ences in logistics and supply chain management
in China, U.K., and New Zealand. His research
papers have been published in international oper-
ations and supply chain management journals. His
research interests include supply chain management, logistics, and 3PL
purchasing.
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