University of Minnesota, School of Public Health, State Health Access Data Assistance Center 2221 University Avenue, Suite 345, Minneapolis, MN, 55414, United States.
Office of Health Policy, Office of the Assistant Secretary for Planning and Evaluation, Room 447D--Hubert H. Humphrey Building 200 Independence Avenue SW, Washington, DC, 20201, United States.
Res Social Adm Pharm. 2021 Jun;17(6):1166-1173. doi: 10.1016/j.sapharm.2020.09.002. Epub 2020 Sep 8.
Health insurance is complex, cost are continuously rising, and people are assuming more of these costs. Health insurance literacy (HIL) is related to healthcare access, yet there is no agreement about how best to measure HIL.
Contrast two HIL measures. First, evaluating their association with demographic characteristics, insurance type, and health status. Second, comparing how these distinct measures relate to access, forgone care, and financial burden of health care.
Data are from a 2017 telephone survey focused on health insurance coverage and access. Participants were randomly assigned either the 4-item likelihood of proactive use scale or a 4-item measure of confidence in use of insurance. Logistic regressions assess correlates of each HIL measure and their association with a range of access measures.
For both measures, 25% of insured adults report high HIL. Few demographic and health status measures are associated with high HIL and they are different for each measure. For both measures, high HIL translates into reports of having a usual source of care and confidence in getting care when needed. The HIL measures behave in opposite ways for forgone care due to costs and problems paying medical bills. Adults scoring high on the likelihood measure are more likely to forgo care and report financial burden. By contrast, adults scoring high on the confidence measure are less likely to forgo care and report burdensome medical bills.
The two measures capture different concepts and raise the question of whether reporting a likely behavior or being confident of that behavior are predictive when it is time to use health insurance. Because HIL is measured at the same time as the outcomes, we reason that the likelihood measure is capturing peoples' past experience using insurance and may result in more proactive use of insurance in the future.
医疗保险复杂且费用不断上涨，人们需要承担更多费用。健康保险知识（HIL）与医疗保健的获取有关，但目前尚无关于如何最佳衡量 HIL 的共识。
对比两种 HIL 衡量标准。首先，评估它们与人口统计学特征、保险类型和健康状况的关系。其次，比较这两种截然不同的衡量标准与医疗保健获取、放弃治疗以及医疗保健经济负担的相关性。
数据来自于 2017 年一项关于医疗保险覆盖范围和获取途径的电话调查。参与者被随机分配到 4 项主动使用可能性量表或 4 项使用保险信心量表中。逻辑回归评估了每种 HIL 衡量标准的相关性及其与一系列获取措施的关联。
对于两种衡量标准，25%的参保成年人报告了较高的 HIL。很少有人口统计学和健康状况指标与高 HIL 相关，且两种衡量标准的相关指标不同。对于两种衡量标准，高 HIL 都表现为有常规医疗服务提供者和在需要时获得医疗服务的信心。由于费用和支付医疗费用的问题，两种衡量标准对因费用而放弃治疗和报告经济负担的情况有相反的影响。在可能行为报告或对行为有信心的情况下，高可能性衡量标准的成年人更有可能放弃治疗并报告经济负担。相比之下，高信心衡量标准的成年人更不可能放弃治疗并报告医疗费用负担沉重。
这两种衡量标准捕捉到了不同的概念，并提出了一个问题，即在使用医疗保险时，报告可能的行为或对该行为有信心是否具有预测性。由于 HIL 是在与结果同时测量的，我们认为可能性衡量标准反映了人们过去使用保险的经验，并且可能会导致未来更积极地使用保险。
