Predictors of Health Insurance Literacy Among University Employees

Background: Health insurance literacy (HIL) is “the degree to which individuals have the knowledge, ability, and confidence to find and evaluate information about plans, select the best plan for their own or their families’ financial and health circumstances and use the plan once enrolled”. Many Americans have low health insurance literacy, but this concept has not been studied to the same extent as general health literacy. Objective: The purpose of this study was to explore predictors of health insurance literacy among employees of a large public institution of higher education in the South-Atlantic. Design: This single-setting cross-sectional study employed an online, anonymous survey administered to approximately 3,000 employees at a large university in the USA after open enrollment in state health insurance. The survey measured demographics and included a validated measure of health insurance literacy. Results: Using several multivariate regression models, results (N=480) indicated high overall HIL. Subscale means were highest for likelihood of using insurance plans proactively and confidence comparing insurance plans but were lower for confidence choosing and using insurance plans, indicating lack of understanding that may lead to poor insurance coverage choice and use. Employment category, income, race, and age also predicted HIL. Discussion: Based on the results, there is an opportunity for employers to provide information about health insurance policies. Health promotion programs should also seek to increase HIL through educational programs and policies to ensure both adequate coverage and ability to use health insurance in such a way that it promotes and protects one’s health.

Psychometric Evaluation of a 10-Item Health Insurance Knowledge Scale

BackgroundCollege students are a priority population for health insurance literacy interventions. Yet, there are few psychometric studies on measuring health insurance knowledge – a core construct of health insurance literacy.MethodsWe administered a health insurance survey to 2,250 college students. We applied Classical Test Theory and Item Response Theory methods to estimate psychometric properties of the Kaiser Family Foundation's 10-item health insurance knowledge quiz.ResultsThe scale is unidimensional, and a two-parameter logistic model best fit the data. IRT estimates indicated varying item discriminations (a range: 0.717–2.578) and difficulties (b range: −0.913–1.790). Precision of measurement was maximized for students half a standard deviation below the mean (θ = −0.686) health insurance knowledge ability.ConclusionsThis scale can be used to identify gaps in health insurance knowledge among college students and be applied in clinical and community health education practice.

Informed Decision-making for Health Insurance Enrollment: Survey Study (Preprint)

BACKGROUND Health insurance enrollment is a difficult financial decision with large health impacts. Challenges such as low health insurance literacy and lack of knowledge about choosing a plan further complicate this decision-making process. Therefore, to support consumers in their choice of a health insurance plan, it is essential to understand how individuals go about making this decision. OBJECTIVE This study aims to understand the sources of information used by individuals to support their employer-provided health insurance enrollment decisions. It seeks to describe how individual descriptive factors lead to choosing a particular type of information source. METHODS An introduction was presented on health insurance plan selection and the sources of information used to support these decisions from the 1980s to the present. Subsequently, an electronic survey of 151 full-time faculty and staff members was conducted. The survey consisted of four sections: <i>demographics, sources of information, health insurance literacy,</i> and <i>technology acceptance</i>. Descriptive statistics were used to show the demographic characteristics of the 126 eligible respondents and to study the response behaviors in the remaining survey sections. Proportion data analysis was performed using the Cochran-Armitage trend test to understand the strength of the association between our variables and the types of sources used by the respondents. RESULTS In terms of demographics, most of the respondents were women (103/126, 81.7%), represented a small household (1-2 persons; 87/126, 69%), and used their insurance 3-12 times a year (52/126, 41.3%). They assessed themselves as having moderate to high health insurance literacy and high acceptance of technology. The most selected and top-ranked sources were <i>Official employer or state websites</i> and <i>Official Human Resources Virtual Benefits Counselor Alex</i>. From our data analysis, we found that the use of official primary sources was constant across age groups and health insurance use groups. Meanwhile, the use of friends or family as a primary source slightly decreased as age and use increased. CONCLUSIONS In this exploratory study, we identified the main sources of health insurance information among full-time employees from a large state university and found that most of the respondents needed 2-3 sources to gather all the information that they desired. We also studied and identified the relationships between individual factors (such as age, gender, and literacy) and 2 dependent variables on the types of primary sources of information. We encountered several limitations, which will be addressed in future studies. CLINICALTRIAL

User Interactions With Health Insurance Decision Aids: User Study With Retrospective Think-Aloud Interviews (Preprint)

BACKGROUND Two barriers to effective enrollment decisions are low health insurance literacy and lack of knowledge about how to choose a plan. To remedy these issues, digital decision aids have been used to increase the knowledge of plan options and to guide the decision process. Previous research has shown that the way information is presented in a decision aid can impact consumer choice, and existing health insurance decision aids vary in their design, content, and layout. Commercial virtual benefits counselors (VBCs) are digital decision aids that provide decision support by mimicking the guidance provided by an in-person human resources (HR) counselor, whereas more traditional HR websites provide information that requires self-directed navigation through the system. However, few studies have compared how decision processes are impacted by these different methods of providing information. OBJECTIVE This study aims to examine how individuals interact with two different types of health insurance decision aids (<i>guided</i> VBCs that mimic conversations with a real HR counselor and <i>self-directed</i> HR websites that provide a broad range of detailed information) to make employer-provided health insurance decisions. METHODS In total, 16 employees from a local state university completed a user study in which they made mock employer-provided health insurance decisions using 1 of 2 systems (VBC vs HR website). Participants took part in a retrospective think-aloud interview, cued using eye-tracking data to understand decision aid interactions. In addition, pre- and postexperiment measures of literacy and knowledge and decision conflict and usability of the system were also examined. RESULTS Both the VBC and HR website had positive benefits for health insurance knowledge and literacy. Previous health insurance knowledge also impacted how individuals used decision aids. Individuals who scored lower on the pre-experiment knowledge test focused on different decision factors and were more conflicted about their final enrollment decisions than those with higher knowledge test scores. Although both decision aids resulted in similar changes in the Health Insurance Literacy Measure and knowledge test scores, perceived usability differed. Website navigation was not intuitive, and it took longer to locate information, although users appreciated that it had more details; the VBC website was easier to use but had limited information. Lower knowledge participants, in particular, found the website to be less useful and harder to use than those with higher health insurance knowledge. Finally, out-of-pocket cost estimation tools can lead to confusion when they do not highlight the factors that contribute to the cost estimate. CONCLUSIONS This study showed that health insurance decision aids help individuals improve their confidence in selecting and using health insurance plans. However, previous health insurance knowledge plays a significant role in how users interact with and benefit from decision aids, even when information is presented in different formats.