Health Insurance Literacy Research Articles

HEALTH INSURANCE KNOWLEDGE AND HEALTH INSURANCE SELF-EFFICACY IN ADOLESCENTS AND YOUNG ADULTS WITH IBD

Abstract BACKGROUND AND AIMS In the United States, health insurance is a prerequisite for healthcare affordability. Adolescents and young adults with inflammatory bowel disease (AYA-IBD) often require costly therapies, and health insurance knowledge and health insurance self-efficacy are essential for a successful transition from pediatric to adult centered care. Nevertheless, little is known about AYA-IBD knowledge of and familiarity with health insurance. METHODS English-proficient AYA-IBD 15 years and older receiving care at an academic pediatric practice were invited to participate. Participants performed surveys on health insurance knowledge and health insurance self-efficacy. Descriptive statistics were performed to report survey results. Analyses of responses by demographic categories were performed using ANOVA analyses. RESULTS Fifty AYA-IBD completed the surveys. Thirty AYA-IBD were 15-17y and twenty were 18-22y. The majority of respondents were male (27), white (38), non-Hispanic (34), and had Crohn's disease (33). The median (interquartile range) disease duration was 33 (13, 61) months. Most had been on biologic or small molecule IBD therapy (46). All had health insurance: 32 had private insurance, 5 military insurance, and 13 government insurance. The majority (58%) of AYA-IBD answered less than half of the health insurance knowledge questions correctly (Table 1). Reported self-efficacy in choosing and using health insurance was slight to moderate (Table 2). Answers did not vary by demographic groupings. CONCLUSIONS AYA-IBD demonstrated suboptimal health insurance knowledge and slight to moderate health insurance self-efficacy. Our findings identify an important opportunity to provide much-needed health insurance education to help prepare AYA-IBD to manage the costs of medical care. Table 1 AYA-IBD Health Insurance Knowledge Survey Responses Table 2 Health Insurance Literacy Measure (Self-efficacy) Questions and Response Distributions

Unmet need for medical care among Medicare beneficiaries by health insurance literacy and disability

BackgroundNavigating the US healthcare system requires considerable health insurance literacy, especially for adults with disabilities. Limited health insurance literacy may lead to suboptimal treatment, leading to unmet need for medical care. ObjectiveWe examined whether unmet need for medical care among Medicare beneficiaries differs by health insurance literacy and disability status. MethodsUsing data from the 2010–2019 Medicare Current Beneficiary Survey, we identified 48,989 Medicare beneficiaries, including those in traditional Medicare and Medicare Advantage. Our outcomes were three measures of unmet need for medical care. Our key independent variables were health insurance literacy and disability status. For each outcome, we estimated the adjusted rates of reporting unmet need for medical care by health insurance literacy and disability while controlling for individual-level characteristics. ResultsUnmet need for medical care was higher among Medicare beneficiaries with disabilities across all outcomes, but the highest rates were among those with disabilities and limited health insurance literacy (27.4% [95% CI: 24.9–29.9] for experiencing delayed care, 17.7% [95% CI: 15.6–19.9] for experiencing trouble in getting needed care, and 20.8% [95% CI: 18.5–23.1] for not seeing a doctor despite medical need). Notably, there was an increasing trend in experiencing delayed care and trouble getting needed care among Medicare beneficiaries with disabilities over time, especially for those with limited health insurance literacy. ConclusionsMedicare beneficiaries with disabilities and limited health insurance literacy face disproportionate unmet need for medical care. Policies are needed to ensure that these beneficiaries have access to clear and accessible health insurance information.

Health insurance literacy among patients receiving outpatient cancer treatment.

339 Background: Limited health insurance literacy (HIL) has been linked to problems paying medical bills or delaying care among patients with cancer. In this study, we describe the prevalence and correlates of HIL in a cohort of cancer patients measured using a ten-question HIL quiz developed by the Kaiser Family Foundation. Methods: We examined HIL in 393 adult patients (aged >18 years) receiving cancer treatment in two ambulatory infusion centers, Mayo Clinic in Phoenix, Arizona (12/2019 to 2/2020 and 8/2020 to 10/2020) and University of Mississippi Medical Center in Jackson, Mississippi (9/2020 to 1/2021). HIL was categorized as low, moderate, or high based on the total number of correct answers: 0-4 (low), 5-6 (moderate), and 7-10 (high). Descriptive statistics characterized the sample and chi-square statistics compared HIL by sociodemographic factors. Results: Most patients understood basic insurance terms, such as premiums and deductibles (Table). However, fewer patients answered questions correctly about provider networks (46.1%), formularies (48.6%), and calculating out-of-pocket (OOP) spending (16.8%). 53 (13.5%), 69 (17.6%), and 271 (69.0%) patients had low, moderate, and high HIL scores, respectively. Lower HIL was more common among patients of younger age (<65 years: 17.8%, 65+ years: 8.7%), lower educational attainment (less than college: 23.2%; college or higher: 4.4%), and lower household income (<$4999: 21.1%, $5000+: 6.1%) (all p-values<0.05). Conclusions: Although HIL in our cohort of cancer patients was relatively high - 69% answered at least 7 questions correctly - there were gaps in understanding of provider networks, formularies, and calculation of OOP spending. Efforts to improve HIL and help with navigation of health insurance plans may be required, especially for socioeconomically vulnerable patients.[Table: see text]

Assessing the feasibility and preliminary effects of a health insurance navigation intervention for colorectal cancer survivors.

506 Background: Colorectal cancer survivors are at-risk for being underinsured and experiencing health insurance-related financial burden. Low health insurance literacy (HIL) reduces survivors’ ability to utilize health insurance. We conducted a pilot randomized controlled trial to assess the feasibility and preliminary effects of a virtually-delivered health insurance navigation tool (HINT) intervention to improve HIL and decrease financial burden among colorectal survivors. Methods: We tested a theoretically-driven 5-session intervention that included: 1) Learning About Survivorship Healthcare Needs; 2) Learning About Your Plan in Relation to Policy; 3) Navigating One’s Own Plan and Overcoming Obstacles; 4) Managing Care Costs; and 5) Understanding Your Medical Bills and Review. Eligibility included patients treated for colorectal cancer at Mass General Cancer Center, insured, and with access to wireless device. We assessed the feasibility and preliminary effects of HINT vs enhanced usual care (EUC; health insurance booklet) on HIL (assessing knowledge and confidence with health insurance terms and activity, knowledge of Affordable Care Act [ACA]), psychological financial burden (assessing worry due to medical costs), and satisfaction with health insurance coverage. Paired t-tests and cohen’s d were used to explore pre-post changes within the HINT and EUC groups from baseline (BL) to 5-month follow-up (FU). Results: From 1/22-2/23, we enrolled 34 participants (63% enrollment rate); 41.7% female; 88.2% white, Mean age=49.7 years. 82.7% of HINT participants completed all 5 intervention sessions. There were gaps in HIL (HIL mean 29.1, sd=7.9; 16-60 (high-low); 41.2% were not familiar with the ACA. 31/34 (91%) completed the 5-month follow-up survey. Among HINT participants, HINT significantly improved HIL and ACA knowledge; there was a non-significant trend toward reduced psychological financial burden and decreased health insurance satisfaction (see Table). Among EUC participants, there was a non-significant trend toward reduced psychological financial burden and no changes in any other variables. Clinical trial information: NCT05002608 .[Table: see text]

The role of health insurance literacy in the process and outcomes of choosing an insurance policy

Abstract Background Several countries have healthcare systems that require their citizens to make informed and thoughtful decisions about which health insurance policy fits their needs and preferences best. There are indications that citizens do not always have sufficient skills, so called health insurance literacy (HIL), to do this. This can lead to citizens being sub-optimally insured, suffering inadequate coverage and facing unexpected costs. This study aims to investigate whether the level of HIL among Dutch citizens is related to the way in which they experience the process of choosing a policy, and furthermore whether it is related to their health insurance choices. Methods A mixed-mode questionnaires was distributed to 1,500 participants of the Nivel Dutch Health Care Consumer Panel in February 2020. The response rate was 54% (n = 806). Regression analyses were performed to gain a better understanding of the association of HIL with the process and outcomes regarding the choice of a health insurance policy. Results Respondents with a low HIL, in comparison to those with a high HIL, find choosing a health insurance policy more often difficult, not interesting, and boring, and less often consider it important and worthwhile (p < 0.01 for all). Also, they make less use of their opportunity to switch from one health insurer to another (p < 0.05). However, they do opt for a supplementary insurance policy and a voluntary deductible to the same extent as respondents with a high HIL. Conclusions The level of HIL among Dutch citizens is related to the way they experience the process of choosing a health insurance policy, and to the extent to which they switch from one health insurer to another, but not to their health insurance choices. It is important to get a better understanding of the barriers citizens with a low HIL experience during this process, and of their needs and preferences. Key messages • The level of HIL is related to the way Dutch citizens experience the process of choosing a health insurance policy. • Compared to those with a high HIL, Dutch citizens with a low HIL switch health insurers less often, but opt for a supplementary policy and a voluntary deductible to the same extent.

Assessing health insurance literacy in Switzerland: first results from a measurement tool.

Health insurance literacy (HIL) is crucial for individuals to make informed-decisions and navigate complex choice-based health insurance systems. However, there is a lack of evidence on HIL in countries outside the US, with Switzerland no exception. Using the HILM-CH, a survey instrument developed to measure HIL in Switzerland, this study first describes the answers to the HILM-CH. Second, the study uses ordinary least squares and quantile regressions to investigate the associations between the HIL score and demographic, socioeconomic, health, and preference factors in the German, French, and Italian Swiss regions. A third of the population faces difficulties in finding health insurance information. Understanding it and managing the financial aspects of the Swiss health insurance system pose the biggest barriers to the population. The HIL score significantly and positively correlates with age and financial risk, while non-Swiss individuals have lower HIL scores. No association was found between HIL, gender, education and time preference. There is a small health gradient, with more doctor visits associated with higher HIL in the lowest quantiles of the HIL score. Similarly, wealthier individuals in the Swiss German part of Switzerland have a higher HIL when choosing their health insurance. This study provides important insights into Swiss HIL and its associated factors. These findings contribute to the international literature on HIL and highlight the importance of understanding variations in HIL and various factors in choice-based health insurance systems.

Health Insurance Literacy and Medical Care Avoidance Among International Students: A Case Study.

Objectives: This research examines the health insurance literacy and healthcare utilization of international students attending a university in the US Midwest. Methods: One hundred and forty-three undergraduate and graduate students attending a midsize metropolitan university in the Midwest completed an online survey in early 2022. Results: Many students surveyed could not identify the definitions of basic terms, such as copay. Furthermore, about 80% of students surveyed could not determine their financial responsibilities in two medical settings. Regression results show that the continent they are from and the length of their stay in the United States significantly predict their understanding of key health insurance terms. More than half of the international students surveyed indicated they often feel confused about their health insurance (57.34%). Only about 20% have delayed or skipped care due to unfamiliarity with the health insurance system. Conclusion: The health insurance literacy of most international students at the midwestern university we surveyed is not ideal. This and possibly other universities in the United States should take more initiatives to help their international students understand the health insurance system.

A Study on National Health Insurance Literacy among International Students in Korea and Their Medical Service Use

This study aimed to examine international students’ perceptions, characteristics, use of public medical services, and satisfaction with the National Health Insurance System, and compared the results with the Health Insurance System Perception Survey conducted on Korean population to understand the differences between the two groups’ perceptions of the health insurance system and their use of medical services.A survey was conducted from May 23, 2022 to June 21, 2022 to measure various data of international students related to the National Health Insurance System and analyzed the results.Most international students were in their 20s (the average age was 23±2.06 years), which showed that they were less likely to use medical services compared to Korean population in their 20s. Both Korean population and international students viewed their subjective health as generally good. Regarding the perceptions of the National Health Insurance System, 75.6% of the Korean population responded positively, while only 16% of international students responded positively. The biggest reason for the negative responses was the higher contributions compared to private health insurance, showing that financial hardship played a large role in the negative perceptions. The insurance contribution calculation methods by the Government showed differences. International students receive the same insurance contributions regardless of their nationality, age, income, or assets.Through this study, it has been confirmed that further research and examination are needed regarding the application of Korean health insurance to foreign residents and the appropriate calculation of insurance contributions.

The role of health insurance literacy in the process and outcomes of choosing a health insurance policy in the Netherlands

In several countries, citizens are expected to be critical consumers when choosing a health insurance policy. However, there are indications that citizens do not always have the sufficient skills, so called health insurance literacy (HIL), to do this. We investigated whether the level of HIL among Dutch citizens is related to the way in which they experience the process of choosing a policy, and furthermore whether it is related to their health insurance choices. We obtained information by sending questionnaires to members of the Nivel Dutch Health Care Consumer Panel in 2020. Of the 1,500 approached, 806 panel members participated (response rate 54%). Our results indicate that, compared to those with a high HIL, respondents with a low HIL more often find choosing a health insurance policy difficult, not interesting, and boring, and less often consider it important and worthwhile. Furthermore, they make less use of the opportunity to switch from one health insurer to another. However, they do still opt for a supplementary insurance policy and a voluntary deductible to the same extent as citizens with a high HIL. We conclude that the HIL level among Dutch citizens is related to the way in which they experience the process of choosing a health insurance policy and to the extent to which they switch from one insurer to another. But it is not related to their health insurance choices. Follow-up research should focus on how citizens with a low HIL can be better supported when choosing a health insurance policy.

Relationships Among Health Insurance Literacy, Financial Toxicity, and Sociodemographic Factors in Patients With Cancer.

The objective of the study was to describe the prevalence of health insurance literacy (HIL) and investigate how patient-reported outcome measures assessing HIL are related to financial toxicity in patients with cancer. We assessed HIL and financial toxicity in 404 patients enrolled between December 2019 and January 2021 at two medical centers in the United States. We conducted exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to explore and test the relationships among the factors and items. We fit structural equation models (SEMs) to find the relationships among the factors and sociodemographic/clinical characteristics. The EFA revealed items loaded on four factors: knowledge about health insurance, confidence related to HIL (HIL confidence), information-seeking behavior related to health insurance, and financial toxicity. The four-factor CFA model had good fit statistics (comparative fit index, 0.960; Tucker-Lewis index, 0.958; root mean square error of approximation, 0.046; and standardized root mean square residual, 0.086). In SEM, income, education level, and race positively predicted knowledge about health insurance. Knowledge about health insurance and number of total lines of cancer treatment was positively associated with HIL confidence. Higher income, older age, and HIL confidence were associated with less financial toxicity. Higher levels of financial toxicity, HIL confidence, and knowledge were associated with greater information-seeking behavior. Our findings showed how different aspects of HIL are related to financial toxicity even after adjustment for sociodemographic and clinical characteristics. Future studies should investigate the longitudinal relationships among these factors to help develop interventions to mitigate financial toxicity.

"It's just not easy to understand": A mixed methods study of health insurance literacy and insurance plan decision-making in cancer survivors.

Understanding cancer survivors' health insurance decision-making is needed to improve insurance choice, potentially resulting in reduced financial hardship. This explanatory mixed methods study assessed health insurance decision-making in cancer survivors. Health Insurance Literacy Measure (HILM) captured HIL. Quantitative eye-tracking data collected from two simulated health insurance plan choice sets gauged dwell time (seconds), or interest, in benefits. Dwell time differences by HIL were estimated using adjusted linear models. Qualitative interviews explored survivors' insurance decision-making choices. Cancer survivors (N = 80; 38% breast cancer) had a median age of 43 at diagnosis (IQR 34-52). When comparing traditional and high-deductible health plans, survivors were most interested in drug costs (median dwell time 58 s, IQR 34-109). When comparing health maintenance organization and preferred provider organization plans, survivors were most interested in test/imaging costs (40s, IQR 14-67). Survivors with low versus high HIL had more interest in deductible (β = 19 s, 95% CI 2-38) and hospitalization costs (β = 14 s, 95% CI 1-27) in adjusted models. Survivors with low versus high HIL more often ranked out-of-pocket (OOP) maximums and coinsurance as the most important and confusing benefits, respectively. Interviews (n = 20) revealed survivors felt alone "to do their own research" about insurance choices. OOP maximums were cited as the deciding factor since it is "how much money is going to be taken out of my pocket." Coinsurance was considered "rather than a benefit, it's a hindrance." Interventions to aid in health insurance understanding and choice are needed to optimize plan choice and potentially reduce cancer-related financial hardship.

The Imperative Role of the Library in Health Insurance Information Needs in Nigeria

This study provides a springboard for stakeholders in health, Health Maintenance Organizations (HMOs) and library (information professionals) to undertake a possible and effective way to improving health insurance literacy and participation in Nigeria. The authors in this study posited creative approaches to using Libraries in Nigeria to improve the awareness of Nigerians on the benefits of the compulsory new Health Insurance Programme through viable partnership with governments at all levels, local and international Non-Governmental Organizations, based on the fact that libraries have succeeded in partnering with the stakeholders in the health sector in different countries of the world to achieve HI needs. Opinion Piece was used as method of research to buttress the clarity of the research perspective. The paper illuminated on some of the roles of the library in Health Insurance Information Needs such as availability of information resources on health insurance, health insurance literacy workshops, reference and research services, assistance with online insurance forms, partnerships with organizations, language and cultural accessibility, confidentiality, education and outreach.

Cost of Cancer in Adolescents and Young Adults in the United States: Results of the 2021 Report by Deloitte Access Economics, Commissioned by Teen Cancer America.

The purpose of this report, commissioned by Teen Cancer America and performed by Deloitte Access Economics in 2021, was to estimate the total costs incurred by adolescent and young adults (AYAs) after cancer diagnosis in the United States (US) over their life course. The incidence of cancer in 2019 among AYAs age 15-39 years was estimated from the US Cancer Statistics Public Use Database, and relative survival was projected from the Surveillance, Epidemiology, and End Results Program. Cost domains included health system, productivity, and well-being costs. Components were estimated with published literature and pooled data from the Medical Expenditure Panel Survey from 2008 to 2012 and inflated to 2019 dollars. The economic and human costs of cancer in AYAs are substantial-$23.5 billion overall, corresponding to $259,324 per person over the lifetime. The majority of costs are borne by AYA cancer survivors themselves in the form of lost productivity, loss of well-being, and loss of life. These findings underscore the need to address the burden of cancer in AYAs through targeted programs for AYAs, such as financial navigation and health insurance literacy interventions, as well as local and national policy initiatives to address access to and enhanced coverage for clinical trials participation, fertility services, and survivorship care.

Adaptation and Development of a Health Insurance Education Program for Adolescent and Young Adult Cancer Patients.

Introduction: Adolescent and young adult (AYA) cancer patients report low health insurance literacy. We interviewed AYAs to gain their perspectives on the content and delivery of the Huntsman-Intermountain adolescent and young adult cancer health insurance (HIAYA CHAT) program. Methods: From October 2019 to March 2020, we interviewed N = 24 insured AYAs with cancer aged 18-39 years. Participants were recruited by study staff and social media. We elicited feedback on proposed HIAYA CHAT content including insurance terms/definitions, insurance coverage components, insurance legislation, cost management, and the suitability of the intervention delivery. Interviews were audio recorded, transcribed, and inductively analyzed using NVivo 12. We coded feedback into three categories of results: (1) delivery of HIAYA CHAT, (2) endorsements of proposed HIAYA CHAT content, and (3) recommendations to expand and improve HIAYA CHAT. Results: Participants were 58% female, 79% non-Hispanic white, and 79% receiving cancer treatment. First, AYAs felt that three to four different content areas, each 30 minutes or less, seemed feasible and that delivery should be through an online platform. Second, participants reflected on times during their treatment when having more insurance knowledge (e.g., appeals process) would have been useful, endorsing content about insurance policies, legal protections, and legislative impacts on health care costs. Third, AYAs recommended evaluating patients' health insurance literacy before starting HIAYA CHAT and wanted concrete learning tools (e.g., sample medical bills and budgeting). Conclusion: AYAs with cancer wanted health insurance education to include information about insurance policies and protections using tangible examples through an online delivery. Describing AYAs preferences for interventions may improve relevance and efficacy of the program. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT04448678.

The Swiss Health Insurance Literacy Measure (HILM-CH): Measurement Properties and Cross-Cultural Validation

BackgroundMost consumers face difficulties when choosing and navigating health insurance plans. Health insurance literacy (HIL) has been discussed as a critical lever to ensure efficient choices and navigation in choice-based health insurance systems. Still, existing evidence about HIL mainly comes from the US, and the only validated scale, the Health Insurance Literacy Measure (HILM), may not be adequate to measure HIL outside US samples. This paper describes the measurement properties of the Swiss Health Insurance Literacy Measure (HILM-CH), the first scale to measure HIL in Switzerland.MethodsThe items of the HILM-CH were adapted from the HILM in German, French, and Italian. A panel of experts refined it to ensure its suitability for the Swiss context. The final version of the HILM-CH contains 21 items, and other relevant measures were administered in the Swiss Health Insurance Literacy Survey to a sample of 6036 insurees. Measurement properties were investigated overall and per linguistic group. Internal reliability was determined using Cronbach’s alphas. Criterion validity was examined through convergent and concurrent validity of the HILM-CH. The construct validity was assessed using factor analysis. Measurement invariance of the HILM-CH between linguistic regions was further evaluated using multiple-group confirmatory factor analyses.ResultsThe HILM-CH had acceptable to good reliability (alphas between 0.70 and 0.91). Concurrent and convergent validity showed that HILM-CH is a good measurement of HIL. Factor analysis revealed a four-factor model and showed an acceptable fit to the data (CFI= 0.977; TLI = 0.974; RMSEA = 0.061; SRMR = 0.032). Using the established four-factor model, measurement invariance was established across Switzerland’s German, French, and Italian-speaking regions.ConclusionsThe HILM-CH is a reliable and valid measure of HIL across Switzerland’s German, French, and Italian-speaking regions. It can be used in future research to find associations between HIL and individual characteristics.

The Urgency of Health Insurance Literacy for Indonesian People: Between Smoking and Paying JKN Premium

Introduction: Declining the rates of smoking among the poor still becomes a challenge for the health sector. Ideally, they can use the money for smoking to pay for their family health insurance premium. This research aimed to analyze how the poor in the informal sector perceived the payment of National Health Insurance (NHI/ JKN) using the cigarette cost.Methods: Data were collected from focus group discussions (FGD) in three different locations, Deli Serdang, Sumedang Districts and Medan City. Thirty-three informal sector workers with low financial capabilities participated in these FGDs. Health Belief Model was used as the framework for analyzing the data and information. Data analysis was conducted through the content analysis method.Results: The finding showed that poor people who work in the informal sector gave two different responses regarding the use of cigarette costs for paying the NHI/JKN program premium. The respondents had already an excellent perceived susceptibility and severity both on smoking habits and their low finance condition. They believed that the NHI/JKN benefit was to protect them financially if their family members need medical treatment. However, they had low self-efficacy and high perceived barriers that hinder them from replacing the money for buying cigarettes into paying for NHI/JKN premium.Conclusion: An approach to the poor people in the informal sector within their local context, is urgently needed to increase their health insurance literacy and knowledge about smoking.

Moderation effects of co-operative institutions’ capabilities on the relationship between health insurance literacy and participation in health insurance among co-operative members in Tanzania

Moderation effects of co-operative institutions’ capabilities on the relationship between health insurance literacy and participation in health insurance among co-operative members in Tanzania

Usability of Hospital Price Estimators for Lumbar Spine MRI.

The aim of this study was to evaluate the usability of online hospital price estimators for a common imaging examination using surrogate patients. Using the Amazon Mechanical Turk platform, the authors recruited adult English-speaking US residents as surrogate patients to find the cash price for a noncontrast lumbar spine MRI examination for a self-pay patient using price estimator tools at four hospitals. All were asked to view a 3-min tutorial video and report their experiences with the task, including the System Usability Scale (SUS) for the estimator, through a paid survey. Participants were queried about demographics, insurance, prior imaging exposure, and assessed health literacy and health insurance literacy using validated measures. Multivariable analysis for correct price identification and price estimator SUS were performed. Of 660 respondents, 476 met eligibility criteria (72.7% <45 years of age, 41.7% female, 86.1% white); 76.9% found all four estimators, and 9.2% were unable to locate any. Only 27.7% found the correct price at all four hospitals, with 67.4% being able to find at least one correct cash price. Average SUS score for the hospitals' estimators ranged between 62.4 and 77.5. The hospital with a similar estimator to that used in the tutorial video had the highest SUS score. Accuracy of price identification improved with later tasks. Higher health insurance literacy was associated with higher identification of at least one correct price (odds ratio, 1.21; 95% confidence interval, 1.02-1.44) and higher SUS score (B= 1.68; 95% confidence interval, 1.07-2.29). Surrogate patients were able to locate hospital price estimators but unable to effectively use them to obtain correct prices. Tutorial videos improved SUS score, but correct price identification improved with practice.

Understanding the role of financial health literacy in midlife and old age: A scoping review.

As global population ageing persists, understanding older adults' capacity to navigate the financial and healthcare system is essential. This scoping review examines how the concept of financial health literacy (FHL) is described and measured in the existing literature, the factors that may affect it, and its potential outcomes in middle-aged and older adults. The review follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) extension guidelines to synthesise the available evidence on this topic. We utilised electronic databases and hand searching to identify relevant literature published between 2010 and 2022. A total of 29 articles were included in this review. The results showed that FHL involved accessing, understanding and utilising financial information for planning/management of healthcare expenses and selecting appropriate health services. However, FHL is not particularly depicted as a concept in the current literature, as most studies investigated health literacy, financial literacy and health insurance literacy as separate domains that were interrelated to one another. No validated measurement tool was developed for FHL. We propose five domains to indicate the concept and measurement of FHL in middle-aged/older adults: money management, management of medical bills, understanding health insurance, deciding on appropriate health services, and planning for long-term care needs. Demographic variables, such as sex (females), advanced age, cognitive impairment, low education and income and racial and ethnic minorities, were found to be related to low FHL. The reviewed studies also showed that FHL was related to several outcomes, including healthcare decision-making, physical health and psychological well-being. Hence, future studies to develop and validate assessment tools of FHL, together with the involvement of vulnerable groups, are imperative to understanding the concept of FHL. This could also facilitate the development of appropriate interventions that could enhance this capacity in the ageing population.

Measuring Health Insurance Literacy in the Netherlands – first results of the HILM-NL questionnaire

Abstract Background Many Western countries have healthcare systems that expect their citizens to make critical, well-considered decisions about which health insurance policy best fits their needs and preferences. There are indications that citizens struggle to fulfil this role due to the complexity of the healthcare systems and lack of skills, support or motivation. This can lead to citizens being sub-optimally insured, suffering inadequate coverage and facing unexpected costs. To understand how citizens choose and use a policy, the health insurance literacy measure (HILM) was developed in the US. It seems valuable to investigate the concept of Health Insurance Literacy (HIL) in other countries. This study aims to examine how HIL is distributed among citizens in the Netherlands; and to find out whether certain groups have more difficulty choosing and using a health insurance policy. Methods We measured HIL using the HILM-NL questionnaire, a validated and translated version of the HILM. In February 2020, the HILM-NL was sent to 1,500 members of the Nivel Dutch Health Care Consumer Panel. The response rate was 54% (n = 806). Higher HILM-NL scores imply a higher self-assessed ability in choosing and using health insurance. Results There is a wide variation in HIL among citizens in the Netherlands. The average total HILM-NL score is 55.14 (ranging from 21-84). Lower-educated citizens (p&amp;lt;.04) and citizens with lower income (p&amp;lt;.01) are relatively more likely to have lower HIL, than, respectively, higher-educated citizens and citizens with higher income. Conclusions Citizens who completed less education or earn a lower income are relatively more likely to have difficulty choosing and using a health insurance policy. It is important to support these vulnerable groups, so that Dutch citizens in general will be better able to choose a policy that fits their needs and preferences. This should ensure that citizens are less likely have to deal with inadequate coverage and unexpected costs. Key messages • There is a wide variation in HIL among citizens in the Netherlands. • Citizens who completed less education or earn a lower income are relatively more likely to have difficulty choosing and using a health insurance policy.