Renuka Tipirneni|Mary C. Politi|Jeffrey T. Kullgren|Edith C. Kieffer|Susan Dorr Goold|Aaron M. Scherer
Association Between Health Insurance Literacy and Avoidance of Health Care Services Owing to Cost
University of Michigan–Ann Arbor|Washington University in St. Louis|University of Michigan–Ann Arbor|VA Center for Clinical Management Research|University of Michigan–Ann Arbor|University of Michigan–Ann Arbor|University of Iowa
h3importanceh3 navigating health insurance health care choices requires considerable health insurance literacy although recommended preventive services exempt outofpocket costs affordable care act many people may remain unaware provision effect required payment little known association individuals health insurance literacy use preventive nonpreventive health care services h3objectiveh3 assess association health insurance literacy selfreported avoidance health care services owing cost h3design setting participantsh3 survey study us national geographically diverse nonprobability sample 506 us residents aged 18 years older current health insurance coverage recruited participate online survey february 22 23 2016 h3main outcomes measuresh3 validated 21item health insurance literacy measure hilm assessed individuals selfrated confidence selecting using health insurance score range 084 higher scores indicating greater levels health insurance literacy dependent variables included delayed foregone preventive nonpreventive services past 12 months owing perceived costs preventive nonpreventive use services covariates included age sex raceethnicity income educational level highdeductible health insurance plan health literacy numeracy chronic health conditions analyses included descriptive statistics bivariate multivariable logistic regression h3resultsh3 total 506 511 participants began survey completed participation rate 990 506 participants 339 670 younger 35 years mean sd age 34 104 years 228 451 women 406 504 reported race 806 white 245 484 attended college 4 years total 228 participants 451 1 chronic health condition 361 500 722 responded survey item seen physician outpatient setting past 12 months 446 501 890 responded survey item health insurance plan 12 months one hundred fifty respondents 296 reported delayed foregone care cost mean sd hilm score 635 123 multivariable logistic regression 12point increase hilm score associated lower likelihood delayed foregone preventive care adjusted odds ratio aor 061 95 ci 048078 delayed foregone nonpreventive care aor 071 95 ci 055091 h3conclusions relevanceh3 studys findings suggest lower health insurance literacy may associated greater avoidance preventive nonpreventive services appears improve appropriate use recommended health care services including preventive health services clinicians health plans policymakers may need communicate health insurance concepts accessible ways regardless individuals health insurance literacy plain language communication may able improve patients understanding services exempt outofpocket costs