Health Lit Res Pract. 2022 Jan 4;6(2):e62-e69. doi: 10.3928/24748307-20220309-01. Epub 2022 Mar 31.
Despite increases in the number of insured Americans, consumers continue to face barriers in accessing care. Low levels of health insurance literacy (HIL) are associated with suboptimal use of health insurance coverage. There remains a need to further contextualize the relationship between HIL and access to care, especially among insured working-class people. Objective This study was conducted to understand the pathways through which HIL affects health care decision-making and access to care in an urban working-class population.
Using a qualitative descriptive approach, we conducted five focus groups with 45 adult residents of South Louisville, Kentucky. The questions explored participants' experiences of insurance enrollment, use, and health care system navigation, as well as their perceptions and needs regarding accessing health insurance information. Using inductive thematic analysis, transcripts were open coded independently by team members, a focused coding framework was agreed upon, and emergent themes were identified through constant comparison techniques.
Most participants placed high value on their insurance, considering it the most important benefit employers offer. Despite having adequate HIL, most participants expressed frustration with the amount of time and effort they spent to determine the best insurance plan, obtain covered health services, and settle claims, often with ineffective results. Despite having insurance, cost considerations influenced many participants' decisions to accept certain tests or treatments, in some cases resulting in delayed or foregone care.
The findings of this qualitative study indicate that obtaining health care is strongly influenced both by the individual context of HIL knowledge, experience, and life circumstances, and by the structural context of the complex, bureaucratic, and costly health care system. Interventions to improve HIL should include practical examples and real-life scenarios, because HIL gained from experiential narratives was the most useful in navigating the health care system. Plain Language Summary: By conducting focus groups with a working-class population, this study contextualizes the pathways through which HIL affects consumers' health care decision-making and access to care. Findings demonstrate that obtaining health care is strongly influenced both by the individual context of HIL knowledge, experience, and life circumstances, and by the structural context of the complex, bureaucratic, and costly health care system.
尽管美国参保人数有所增加，但消费者在获得医疗服务方面仍面临障碍。健康保险知识水平较低与健康保险覆盖范围的利用不足有关。需要进一步了解健康保险知识水平与获得医疗服务之间的关系，尤其是在参保的工人阶级人群中。本研究旨在了解健康保险知识水平如何影响城市工人阶级人群的医疗保健决策和获得医疗服务的途径。
本研究采用定性描述方法，对肯塔基州南路易斯维尔的 45 名成年居民进行了 5 次焦点小组讨论。这些问题探讨了参与者在保险登记、使用和医疗保健系统导航方面的经验，以及他们对获取健康保险信息的看法和需求。使用归纳主题分析，团队成员独立对转录本进行开放式编码，达成集中编码框架，并通过不断比较技术确定新兴主题。
大多数参与者高度重视自己的保险，认为这是雇主提供的最重要的福利。尽管具有足够的健康保险知识，但大多数参与者对他们花费大量时间和精力来确定最佳保险计划、获得覆盖的医疗服务和解决索赔的情况表示不满，结果往往不尽如人意。尽管有保险，但考虑到成本因素，许多参与者会决定接受某些检查或治疗，在某些情况下导致延迟或放弃治疗。
这项定性研究的结果表明，获得医疗保健服务受到个人健康保险知识、经验和生活环境背景的强烈影响，也受到复杂、官僚主义和昂贵的医疗保健系统结构背景的强烈影响。提高健康保险知识水平的干预措施应包括实际示例和现实生活场景，因为从经验叙事中获得的健康保险知识水平在医疗保健系统导航方面最有用。
