Zhao Jingxuan, Zhang Nan, Hilal Talal, Griffin Joan M, Yabroff K Robin, Khera Nandita
Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, Georgia, USA.
Department of Quantitative Health Sciences, Mayo Clinic, Phoenix, Arizona, USA.
Cancer. 2024 Oct 15;130(20):3480-3486. doi: 10.1002/cncr.35439. Epub 2024 Jul 17.
This study examines patients' understanding of health insurance terms and concepts and quantifies health insurance literacy (HIL) levels by key sociodemographic factors.
This study included 393 adult patients with cancer (>18 years old) receiving treatment in two ambulatory infusion centers: Mayo Clinic in Phoenix, Arizona and the University of Mississippi Medical Center in Jackson, Mississippi. Respondents' perceptions of their HIL were assessed using the Health Insurance Literacy Measure (HILM), a validated 21-item measure of a consumer's ability to select and use health insurance (HIL self-efficacy). Respondents' knowledge of health insurance concepts (HIL knowledge) was measured using 10 items created by the Kaiser Family Foundation. The number of correct answers was categorized into three levels: 0-4 (low knowledge), 5-6 (moderate knowledge), and 7-10 (high knowledge). Multivariable logistic regressions were used to compare correct answers to HIL knowledge questions by HIL self-efficacy.
Nearly three-quarters of patients had high HIL self-efficacy and high HIL knowledge (70.5%), understanding basic insurance terms, such as premiums and deductibles. Relatively low percentages of patients correctly answered questions about the meaning of provider networks, health insurance formularies, and calculating out-of-pocket spending in scenarios when insurers pay a portion of allowed charges. Lower HIL knowledge was more common among patients with less educational attainment (<college: 15.2%; ≥college: 4.7%), lower household income (<$4999: 11.8%; ≥$5000: 6.1%), and low HIL self-efficacy scores (low: 24.8%; high: 5.2) (all p values <.05).
Efforts to improve HIL and navigation of health insurance plan features are required, especially for socioeconomically vulnerable patients.
本研究调查了患者对健康保险条款和概念的理解，并按关键社会人口统计学因素对健康保险素养（HIL）水平进行量化。
本研究纳入了393名在两个门诊输液中心接受治疗的成年癌症患者（年龄>18岁）：亚利桑那州凤凰城的梅奥诊所和密西西比州杰克逊的密西西比大学医学中心。使用健康保险素养量表（HILM）评估受访者对自身HIL的认知，这是一种经过验证的、用于衡量消费者选择和使用健康保险能力（HIL自我效能）的21项量表。使用凯撒家庭基金会编制的10个项目来衡量受访者对健康保险概念的了解（HIL知识）。正确答案的数量分为三个等级：0 - 4（知识水平低）、5 - 6（知识水平中等）和7 - 10（知识水平高）。采用多变量逻辑回归按HIL自我效能比较HIL知识问题的正确答案。
近四分之三的患者具有较高的HIL自我效能和较高的HIL知识（70.5%），理解诸如保费和免赔额等基本保险条款。相对较低比例的患者能正确回答有关提供者网络的含义、健康保险药品目录以及在保险公司支付部分允许费用的情况下计算自付费用等问题。HIL知识水平较低在受教育程度较低的患者中更为常见（<大学学历：15.2%；≥大学学历：4.7%）、家庭收入较低的患者中（<$4999：11.8%；≥$5000：6.1%）以及HIL自我效能得分较低的患者中（低：24.8%；高：5.2）（所有p值<.05）。
需要努力提高HIL以及健康保险计划功能的导航能力，尤其是对于社会经济弱势群体患者。
