Abstract
AimThis systematic literature review aimed to find and summarize the content and conceptual dimensions assessed by quantitative tools measuring Health Insurance Literacy (HIL) and related constructs.MethodsUsing a Peer Review of Electronic Search Strategy (PRESS) and the PRISMA guideline, a systematic literature review of studies found in ERIC, Econlit, PubMed, PsycInfo, CINAHL, and Google Scholar was performed in April 2019. Measures for which psychometric properties were evaluated were classified based on the Paez et al. conceptual model for HIL and further assessed using COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) Risk of Bias checklist and criteria for good measurement properties.ResultsOut of 123 original tools, only 19 were tested for psychometric and measurement properties; 18 of these 19 measures were developed and used in the context of Medicare. Four of the found measures tested for psychometric properties evaluated all four domains of HIL according to Paez et al.’s conceptual model; the rest of the measures assessed three (3), two (8), or one domain (4) of HIL.ConclusionMost measurement tools for HIL and related constructs have been developed and used in the context of the USA health insurance system, primarily in Medicare, while there is a paucity of measurement tools for private health insurances and from other countries. Furthermore, there is a lack of conceptual consistency in the way HIL is measured. Standardization of HIL measurement is crucial to further understand the role and interactions of HIL in other insurance contexts.
Highlights
The selection of a less-than-optimal plan for a specific individual, or the complete lack of coverage, can have severe financial and health consequences (Bhargava and Loewenstein 2015; Bhargava et al 2015, 2017; Flores et al 2017)
After consulting with a librarian and performing a Peer Review of Electronic Search Strategy (PRESS)(McGowan et al 2016), a systematic literature search was conducted in April 2019 to identify studies using quantitative and mixed methods tools aiming to assess health insurance literacy (HIL) and related constructs
Examples of search terms include “health insurance literacy,” “health insurance,” “health plan,” “Medicare,” “knowledge,” “understand*,” or “instrument”
Summary
The selection of a less-than-optimal plan for a specific individual, or the complete lack of coverage, can have severe financial and health consequences (Bhargava and Loewenstein 2015; Bhargava et al 2015, 2017; Flores et al 2017). J Public Health (Berl.): From Theory to Practice a health insurance plan that provides adequate risk protection (Barnes et al 2015). In light of these findings, and the introduction of the Affordable Care Act in the USA, the concept of health insurance literacy (HIL) has gained increasing attention over the past decade. In 2011, a roundtable sponsored by the Consumers Union in the USA that included experts from academia, advocacy, health insurance, and private research firms defined HIL as “the degree to which individuals have the knowledge, ability, and confidence to find and evaluate information about health plans, select the best plan for their own (or their family’s) financial and health circumstances, and use the plan once enrolled” (Quincy 2012b)
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