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MUDRA: Journal of Finance and Accounting
Vol 12 , Issue 2 , July - December 2025 | Pages: 133-159 | Research Paper

Beyond Rationality: The Role of Psychological Biases and Financial Literacy in Health Insurance

 
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Author Details ( * ) denotes Corresponding author

1. Krishna Nambiar, Assistant Professor, Department of Commerce, Payyannur College, Payyannur, Kannur, Kerala, India (krishnanambiar94@gmail.com)
2. * Vineeth KM, Associate Professor, Post Graduate Department of Commerce, Government College Tripunithura, Ernakulam, Kerala, India (vineeth@gcte.ac.in)

Emerging research suggests that financial literacy and cognitive abilities play an important role in individuals’ healthcare and financial decision-making processes. A comprehensive review of literature suggests that a critical gap exists in our understanding of how psychological biases and financial literacy influence health insurance decisions. This study explores the complex interplay between major psychological biases, financial literacy, and investment decisions in the domain of health insurance. Using a CB-SEM technique, we inspected how overconfidence and risk aversion influence individuals’ financial knowledge and their subsequent choices regarding health insurance. Our findings reveal that psychological biases have a significant impact on both financial literacy and investment decisions. Additionally, we discovered that financial literacy serves as a mediator, reducing the negative consequences of biases on investment choices. These conclusions acme the importance of addressing psychological biases and promoting financial literacy to empower individuals to make informed decisions and improve their overall financial well-being, especially when it comes to health insurance.

Keywords

Financial literacy; Financial decision making; Health insurance; Psychological biases

  1. Adepoju, O., Mask, A. & McLeod, A. (2019). Factors associated with health insurance literacy: Proficiency in finding, selecting, and making appropriate decisions. Journal of Healthcare Management, 64(2), 79. Retrieved from https://doi.org/10.1097/JHM-D-18-00021
  2. Ahmad, M. & Shah, S. Z. A. (2022). Overconfidence heuristic-driven bias in investment decision-making and performance: Mediating effects of risk perception and moderating effects of financial literacy. Journal of Economic and Administrative Sciences, 38(1), 60–90. Retrieved from https://doi.org/10.1108/JEAS-07-2020-0116
  3. Almansour, B. Y., Almansour, A. Y., Elkrghli, S. & Shojaei, S. A. (2025). The investment puzzle: Unveiling behavioral finance, risk perception and financial literacy. ECONOMICS, 13(1), 131–151. Retrieved from https://doi.org/10.2478/eoik-2025-0003
  4. Armansyah, R. F. (2022). Herd instinct bias, emotional biases, and information processing biases in Investment decisions. Jurnal Manajemen Dan Kewirausahaan, 24(2), 105–117. Retrieved from https://doi.org/10.9744/jmk.24.2.105-117
  5. Babu, S. & Vineeth, K. M. (2023). Antecedents to ethical investing behaviour. AIP Conference Proceedings, 2773(1), 030008. Retrieved from https://doi.org/10.1063/5.0138 930
  6. Bagozzi, R. P. & Yi, Y. (1988). On the evaluation of structural equation models. Journal of the Academy of Marketing Science, 16(1), 74–94. Retrieved from https://doi.org/10.1007/BF02723327
  7. Bakshi, A. (2020). Voluntary health insurance in India: Trend analysis of public and private insurance companies. MUDRA: Journal of Finance and Accounting, 7(1), 68. Retrieved from https://doi.org/10.17492/mudra.v7i1.195416
  8. Bhageerathy, R., Nair, S. & Bhaskaran, U. (2017). A systematic review of community-based health insurance programs in South Asia: Community health insurance programs in South Asia. The International Journal of Health Planning and Management, 32(2), e218–e231. Retrieved from https://doi.org/10.1002/hpm.2371
  9. Capuano, A. & Ramsay, I. (2011). What causes suboptimal financial behaviour? An exploration of financial literacy, social influences and behavioural economics. SSRN Electronic Journal. Retrieved from https://doi.org/10.2139/ssrn.1793502
  10. Chaurasia, A. & Murari, K. (2024). Emotional intelligence and investment decision making: A systematic review. MUDRA: Journal of Finance and Accounting, 11(1), 169–185. Retrieved from https://doi.org/10.17492/jpi.mudra.v11i1.1112409
  11. Cordray, A. (2019, May 2). Too many people overvalue what they are not and undervalue what they are—Malcolm Forbes. Leadership Colloquium at UMW. Retrieved from https://www.umw.edu/lcpw/2019/05/02/too-many-people-overvalue-what-they-are-not-and-undervalue-what-they-are-malcolm-forbes/
  12. Devina, M. & Vineeth, K. (2019). Validity of winner’s curse hypothesis: Evidence from Indian stock market IPOs during 2018-19. Research Review International Journal of Multidisciplinary, 4(6), 68–70. Retrieved from https://doi.org/10.5281/zenodo.3247225
  13. Dutta, M. M. (2020). Health insurance sector in India: An analysis of its performance. Vilakshan-XIMB Journal of Management, 17(1/2), 97–109. Retrieved from https://doi.org/10.1108/XJM-07-2020-0021
  14. Estelami, H. (2009). Cognitive drivers of suboptimal financial decisions: Implications for financial literacy campaigns. Journal of Financial Services Marketing, 13(4), 273–283. Retrieved from https://doi.org/10.1057/fsm.2008.24
  15. Fornell, C. & Larcker, D. F. (1981). Evaluating structural equation models with unobservable variables and measurement error. Journal of Marketing Research, 18(1), 39–50. Retrieved from https://doi.org/10.2307/3151312
  16. Ganapathi, B. (2014). Does inclusive higher education can help for physical disability handicapped people in India? A comparative analysis. IMPACT: International Journal of Research in Applied, Natural and Social Sciences, 2(5), 1–16.
  17. Ghosh, R. (2023). As investors sow, can they reap? Examining the moderating effect of investment opportunity on the relationship between financial literacy and investment decision. Global Knowledge, Memory and Communication. Retrieved from https://doi.org/10.1108/GKMC-04-2023-0147
  18. Hair, J. F., Black, W. C. & Babin, B. J. (2010). Multivariate data analysis: A global perspective. Pearson Education.
  19. Hair, J. F., Gabriel, M. & Patel, V. (2014). AMOS covariance-based structural equation modeling (CB-SEM): Guidelines on its application as a marketing research tool. Brazilian Journal of Marketing,13(2). Retrieved from https://papers.ssrn.com/Sol3/Papers.Cfm?Abstract_Id=2676480
  20. Johnson, R. D. & Bruce, R. A. (2017). Overconfidence and health insurance decisions. Journal of Risk and Uncertainty, 55(2), 131-153.
  21. Kawamura, T., Mori, T., Motonishi, T. & Ogawa, K. (2021). Is financial literacy dangerous? Financial literacy, behavioral factors and financial choices of households. Journal of the Japanese and International Economies, 60, 101131. Retrieved from https://doi.org/10.1016/j.jjie.2021.101131
  22. Khan, D. (2020). Cognitive driven biases, investment decision making: The moderating role of financial literacy. Retrieved from https://doi.org/10.2139/ssrn.3514086
  23. Khaw, M. W., Li, Z. & Woodford, M. (2017). Risk aversion as a perceptual bias. NBER Working Paper Series, Working Paper 23294. Retrieved from https://www.nber.org/system/files/working_papers/w23294/w23294.pdf
  24. Koriat, A., Lichtenstein, S. & Fischhoff, B. (2017). Reasons for confidence. Journal of Experimental Psychology: Learning, Memory, and Cognition, 43(5), 751-761.
  25. Kramer, L. A. & Weber, J. M. (2012). This is your portfolio on winter: Seasonal affective disorder and risk aversion in financial decision making. Social Psychological and Personality Science, 3(2), 193-199. Retrieved from https://doi.org/10.1177/1948550611415694
  26. Krieger, M. & Felder, S. (2013). Can decision biases improve insurance outcomes? An experiment on status quo bias in health insurance choice. International Journal of Environmental Research and Public Health, 10(6), 2560–2577. Retrieved from https://doi.org/10.3390/ijerph10062560
  27. Kumar, S. & Goyal, N. (2016). Evidence on rationality and behavioural biases in investment decision making. Qualitative Research in Financial Markets, 8(4), 270–287. Retrieved from https://doi.org/10.1108/QRFM-05-2016-0016
  28. Lin, X., Bruhn, A. & William, J. (2019). Extending financial literacy to insurance literacy: A survey approach. Accounting & Finance, 59(S1), 685–713. Retrieved from https://doi.org/10.1111/acfi.12353
  29. Loevinger, J. (1948). The technic of homogeneous tests compared with some aspects of “scale analysis” and factor analysis. Psychological Bulletin, 45(6), 507–529. Retrieved from https://doi.org/10.1037/h0055827
  30. Lusardi, A. (2015). Financial literacy: Do people know the ABCs of finance? Public Understanding of Science. 24(3), 260–271. Retrieved from https://doi.org/10.1177/0963662 514564516
  31. Mahmood, F., Arshad, R., Khan, S., Afzal, A. & Bashir, M. (2024). Impact of behavioral biases on investment decisions and the moderation effect of financial literacy: An evidence of Pakistan. Acta Psychologica, 247, 104303. Retrieved from https://doi.org/10.1016/j.act psy.2024.104303
  32. Mamidala, V., Kumari, P. & Singh, D. (2024). Should I invest or not? Investigating the role of biases and status quo. Qualitative Research in Financial Markets, 16(3), 423–447. Retrieved from https://doi.org/10.1108/QRFM-12-2022-0198
  33. Mandal, A., Kovid, R. K. & Saxena, A. (2023). Investigating influence of financial literacy on investment awareness: Mediating role of risk tolerance. MUDRA: Journal of Finance and Accounting, 10(2), 118–136. Retrieved from https://doi.org/10.17492/jpi.mudra.v10i2.102 2307
  34. Maurya, R. (2023). Financial literacy among salaried women in India. PRAGATI: Journal of Indian Economy, 10(2), 58–76. Retrieved from https://doi.org/10.17492/jpi.pragati.v10i2.10 22304
  35. Mittal, S. K. (2022). Behavior biases and investment decision: Theoretical and research framework. Qualitative Research in Financial Markets, 14(2), 213–228. Retrieved from https://doi.org/10.1108/QRFM-09-2017-0085
  36. Mohanty, S., Patnaik, B. C. M., Satpathy, I. & Sahoo, S. K. (2024). Cognitive biases and financial decisions of potential investors during Covid-19: An exploration. Arab Gulf Journal of Scientific Research, 42(3), 836–851. Retrieved from https://doi.org/10.1108/AGJSR-12-2022-0296
  37. Narayanan, A., Adithyan, V. S. & Vineeth, K. M. (2024). Awareness and perception towards critical illness care insurance. Asian Journal of Management, 15(1), 45–50. Retrieved from https://doi.org/10.52711/2321-5763.2024.00008
  38. Narula, S. (2017). An Examination into the Link between Financial Inclusion, Financial Literacy and Investment Patterns. MANTHAN: Journal of Commerce and Management, 4(1), 51-64. Retrieved from https://doi.org/10.17492/manthan.v4i01.9605
  39. Neena, M. & Vineeth, K. (2018). Consumer awareness towards telematics in insurance. Research Review International Journal of Multidisciplinary, Special Issue ICCMCT(September), 3. Retrieved from https://old.rrjournals.com/conference-proceeding/ consumer-awareness-towards-telematics-in-insurance/
  40. Nikhila, M. N. & Vineeth, K. (2019). Emotional finance: Financial anxiety among salaried individuals with special reference to life insurance. Journal of the Gujarat Research Society, 21(5), 5. Retrieved from http://gujaratresearchsociety.in/index.php/JGRS/article/view/258
  41. Nunnally, J. C. (1978). An overview of psychological measurement. In B. B. Wolman (Ed.), Clinical Diagnosis of Mental Disorders (pp. 97–146). Springer US. Retrieved from https://doi.org/10.1007/978-1-4684-2490-4_4
  42. O’Connor, G. E. & Kabadayi, S. (2020). Examining antecedents of health insurance literacy: The role of locus of control, cognitive style and financial knowledge. Journal of Consumer Affairs, 54(1), 227–260. Retrieved from https://doi.org/10.1111/joca.12266
  43. Patel, N. & Resnick, P. (2018). Health insurance decision-making: A systematic review. Journal of Health Economics, 60, 102-115.
  44. Perappadan, B. S. (2024, September 25). India registers decline in out-of-pocket expenditure for health: Report. The Hindu. Retrieved from https://www.thehindu.com/sci-tech/health/india-registers-decline-in-out-of-pocket-expenditure-for-health-report/article68682766.ece
  45. Podsakoff, P. M., MacKenzie, S. B., Lee, J.-Y. & Podsakoff, N. P. (2003). Common method biases in behavioral research: A critical review of the literature and recommended remedies. Journal of Applied Psychology, 88(5), 879–903. Retrieved from https://doi.org/10.1037/0021-9010.88.5.879
  46. Pompian, M. M. (2006). Behavioral Finance and Wealth Management: How to build optimal portfolios that account for investor biases. Hoboken, NJ: John Wiley & Sons.
  47. Raj, G. (2025). Biases and investment decision: An analysis of demographics using PLS-MGA. International Journal of Accounting & Information Management. Retrieved from https://doi.org/10.1108/IJAIM-08-2024-0282
  48. Sattar, M. A., Toseef, M. & Sattar, M. F. (2020). Behavioral finance biases in investment decision making. International Journal of Accounting, Finance and Risk Management, 5(2), 69. Retrieved from https://doi.org/10.11648/j.ijafrm.20200502.11
  49. Sharma, U. & Vaish, A. (2021). Mukhyamantri Chiranjeevi Yojana: Analysing the affordable health insurance model. PRAGATI: Journal of Indian Economy, 8(2), 133–144. Retrieved from https://doi.org/10.17492/jpi.pragati.v8i2.822107
  50. Sinha, A., Srivastava, S. & Shunmugasundaram, V. (2024). Role of overconfidence as a mediator between behavioral biases and investment decisions in life insurance. MUDRA: Journal of Finance and Accounting, 11(1), 58–84. Retrieved from https://doi.org/10.17492/ jpi.mudra.v11i1.1112404
  51. Soll, J. B. & Klayman, J. (2018). Overconfidence and decision-support tools. Journal of Behavioral Decision Making, 31(3), 357-366.
  52. Sreethamol, P. S., Sulfiya, K. S. & Vineeth, K. M. (2018). Consumers perception towards telematics in insurance. Research Journal of Humanities and Social Sciences, 9(3), 657–662. Retrieved from https://www.indianjournals.com/ijor.aspx?target=ijor:rjhss&volume=9&issu e=3&article=031
  53. Stewart, C. C., Yu, L., Wilson, R. S., Bennett, D. A. & Boyle, P. A. (2019). Healthcare and financial decision making and incident adverse cognitive outcomes among older adults. Journal of the American Geriatrics Society, 67(8), 1590–1595. Retrieved from https://doi.org/10.1111/jgs.15880
  54. Suresh G. (2021). Impact of financial literacy and behavioural biases on investment decision-making. FIIB Business Review, 13(1), 72-86. Retrieved from https://doi.org/10.1177/23197145211035481
  55. Tabachnick, B. G. & Fidell, L. S. (1989). Using multivariate statistics. Harper & Row.
  56. Tavakol, M. & Dennick, R. (2011). Making sense of Cronbach’s alpha. International Journal of Medical Education, 2, 53–55. Retrieved from https://doi.org/10.5116/ijme.4dfb.8dfd
  57. Tiwari, S. (2023). The impact of gender and age perception towards financial investment decision making. International Journal of Management Issues and Research, 12(1), 1–16. Retrieved from https://doi.org/10.69711/Sharda.IJMIR.v12i1.2301
  58. Tlili, F., Chaffai, M. & Medhioub, I. (2023). Investor behavior and psychological effects: Herding and anchoring biases in the MENA region. China Finance Review International, 13(4), 667–681. Retrieved from https://doi.org/10.1108/CFRI-12-2022-0269
  59. Tversky, A. & Kahneman, D. (1981). The framing of decisions and the psychology of choice. Science, 211(4481), 453-458.
  60. Vyshak, P. K. & Jayarajan, T. K. (2024). The psychology of risk tolerance: Analyzing the impact of psychological factors on financial risk tolerance. MUDRA: Journal of Finance and Accounting, 11(2), 79–99. Retrieved from https://doi.org/10.17492/jpi.mudra.v11i2.1122405
  61. Weedige, S. S., Ouyang, H., Gao, Y. & Liu, T. (2019). Decision making in personal insurance: Impact of insurance literacy. Sustainability, 11(23), 6795. Retrieved from https://doi.org/10.3390/su11236795
  62. Xue, R., Gepp, A., O’Neill, T. J., Stern, S. & Vanstone, B. J. (2021). Financial literacy and financial strategies: The mediating role of financial concerns. Australian Journal of Management, 46(3), 437–465. Retrieved from https://doi.org/10.1177/0312896220940762
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