Continued insurance preparedness was defined as a person’s readiness to maintain or resume coverage and to prepare financially for future insurance-related expenditure. The researchers treated it as a forward-looking psychological state rather than as an observed enrollment outcome. The overall model proposed that a present-focused preference for immediate rewards is associated with weaker future orientation and, through that pathway, with lower preparedness for continued participation in China’s basic medical insurance for urban and rural residents.

For Study 1, researchers randomly assigned 211 university students at an undergraduate institution in Guangxi to one of four conditions in a 2 × 2 between-subjects experiment conducted in September 2025. One factor varied whether a medical insurance scenario emphasized immediate enjoyment and short-term benefits or future medical risks, long-term protection and preparation. The other factor described insurance benefits as less favorable than those of comparable peers or as broadly comparable. Students then completed a seven-point Likert measure of future orientation, and the researchers used two-way analysis of covariance while controlling for gender, age, living allowance and household registration status.

The manipulation checks supported the intended differences between the scenario conditions. After covariate adjustment, future-orientation scores averaged 5.061 in the low-immediate-gratification condition and 3.627 in the high condition, a significant framing effect, F(1, 203) = 34.895, p < 0.001, with partial η² = 0.147. The interaction with relative-deprivation framing was also significant, F(1, 203) = 14.344, p < 0.001, with partial η² = 0.066. The adjusted difference between the gratification conditions was 0.754 points under low relative deprivation and 2.116 points under high relative deprivation.

Those results indicate that responses to immediate-gratification framing depended on the relative-deprivation condition. They do not establish a separate main effect of relative deprivation on future orientation. Nor do the manipulation checks exclude other features of the scenarios, including differences in the salience of future-oriented information or perceived insurance value. The experiment therefore provides evidence about responses to specific framing conditions, not evidence that people who inherently prefer immediate rewards differ from those who naturally plan farther ahead.

Study 2 used an online questionnaire administered in October 2025 to a non-probability sample of urban and rural residents in Guangxi. Eligible participants were at least 18 years old, lived in Guangxi and reported being currently or previously enrolled in the resident medical insurance scheme. Recruitment occurred through community WeChat groups, urban and rural resident discussion groups, and the social networks of university students and their families. Of 526 questionnaires collected, 465 passed eligibility and quality checks. The final sample had a mean age of 31.230 years; 51.6% were female, and 58.7% had rural hukou.

Unlike the experiment, the survey measured immediate gratification, future orientation, relative deprivation and continued insurance preparedness as continuous, self-reported constructs. Partial least squares structural equation modeling found that immediate gratification was negatively associated with future orientation, β = −0.443, p < 0.001. Future orientation was positively associated with preparedness, β = 0.418, p < 0.001. Immediate gratification did not have a statistically significant direct association with preparedness, β = −0.062, p = 0.235, but its indirect association through future orientation was negative, β = −0.185, p < 0.001.

Relative deprivation moderated these relationships in the survey model. Its interaction with immediate gratification was negatively associated with future orientation, β = −0.113, p = 0.007, indicating that the negative association was stronger at higher levels of relative deprivation. The conditional indirect association with preparedness also became more negative as relative deprivation increased, β = −0.047, p = 0.007. A multigroup analysis estimated the indirect association at −0.246 among rural-hukou respondents and −0.112 among urban-hukou respondents. The between-group difference was significant before adjustment for multiple comparisons but not afterward, when the adjusted p value was 0.120.

The findings are bounded by the samples and measures. The experiment included undergraduates with relatively similar ages, living conditions and medical insurance experience, while the survey was confined to Guangxi and used non-probability recruitment. All survey constructs were self-reported in one survey wave, limiting assessment of temporal sequence and leaving some potential common-method influence despite diagnostic tests suggesting that substantial common method bias was unlikely. The survey also did not distinguish current from former enrollees or link preparedness to subsequent renewal and payment records. The results therefore identify experimental framing effects and measured statistical associations, but do not establish that future-oriented thinking causes continued insurance coverage or that communication interventions will improve enrollment continuity.

Subject of Research: Psychological correlates of continued medical insurance preparedness among urban and rural residents in China

Article Title: Immediate gratification and continued medical insurance preparedness: the roles of future orientation and relative deprivation

Article References: Shi, L., Zhao, Q., Liu, H., Li, W., Zhao, P., & Liao, C. (2026). Immediate gratification and continued medical insurance preparedness: the roles of future orientation and relative deprivation. Frontiers in Public Health, 14, Article 1987239. https://doi.org/10.3389/fpubh.2026.1987239

Image Credits: AI Generated

DOI: 10.3389/fpubh.2026.1987239

Keywords: medical insurance, insurance preparedness, future orientation, immediate gratification, relative deprivation, scenario experiment, cross-sectional survey, Guangxi, China, Immediate, gratification, continued