Against the backdrop of the continuous deepening of China’s National Centralized Volume-Based Procurement (VBP) policy for pharmaceuticals, both the institutional environment of the chronic disease medication market and patients’ decision-making logic are undergoing profound restructuring. The persistent decline in patients’ purchase intention for originator drugs has thus emerged as a critical practical issue requiring systematic investigation. This study focuses on patients with chronic diseases in mainland China who are dependent on long-term medication. It examines the mechanisms through which health insurance policy support intensity and patients’ level of medical knowledge exert impacts on their intention to purchase originator drugs. Meanwhile, purchase confidence is introduced as a critical mediating variable to contextualize relationships. On this basis, an analytical framework of “institutional support–cognitive capacity-psychological trust-behavioural intention” is constructed and empirically tested. Using a cross-sectional questionnaire survey, 302 valid responses were collected and analysed through partial least squares structural equation modelling (PLS-SEM). The results indicate that both health insurance policy support intensity and medical knowledge level exert significant positive effects on chronic disease patients’ intention to purchase originator drugs, with medical knowledge demonstrating a more pronounced impact. Moreover, purchase confidence plays a significant partial mediating role in the relationships between health insurance policy support, medical knowledge, and purchase intention. These findings suggest that patients’ medication choices are not merely driven by price considerations or institutional constraints but are shaped by trust-based evaluations of payment sustainability, therapeutic stability, and long-term safety, through which institutional information and individual cognition are transformed into behavioural intentions. Theoretically, this study addresses an important gap in the existing literature on volume-based procurement by incorporating patients’ psychological transmission mechanisms into the analytical framework. Practically, it offers empirically grounded insights for achieving a more refined balance between cost-containment objectives and patients’ medication choice autonomy in health insurance policy design. Additionally, it provides guidance for optimising long-term chronic disease medication management through enhanced medical knowledge dissemination and stabilised policy expectations.
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Gan, W., Xiao, M., Yue, Q., Zhang, Y., Zhao, L. (2025) Why Has the Purchase Intention for Originator Drugs Not Disappeared under the Centralised Volume-Based Procurement Policy? An Analysis of the Mechanisms of Health Insurance Policy Support, Medical Knowledge, and Purchase Confidence. Journal of Disease and Public Health, 1(2), 12-30. https://doi.org/10.71052/jdph/PHIF6638