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<.04) and citizens with lower income (p<.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.
Background One way to develop adequate health literacy responsive policy and strategies in hospitals is the use of self-assessment tools to raise awareness, help prioritize action and mobilize stakeholders. In this study we have piloted the French version of the Vienna Health Literate Organisation (V-HLO-fr) tool in three hospitals to explore its feasibility. Methods We performed explorative case studies in the three main hospitals of Liège (Belgium). Our mode of application of the V-HLO-fr was inspired by the ‘RAND Appropriateness’ method: first, individual members of an internal multidisciplinary panel filled out the questionnaire and then the results were discussed collectively in each hospital during a ‘round table’ meeting. The feasibility of the process was assessed by direct observation of the round tables and with semi-structured phone interviews Results The V-HLO-fr tool was fully applied in the three targeted hospitals and the process seems to be acceptable, practicable and integrable. Its mode of application, formalized by taking inspiration from the RAND method, could be further improved, e.g. by paying more attention to recruiting and supporting participants. Strengths (e.g. the facilitation of patient navigation to the hospital) and weaknesses (e.g. the provision of easy to read, understand and act on health information materials) in terms of health literacy responsiveness have been highlighted. Conclusions V-HLO-fr could be a suitable tool to create awareness and formulate targeted actions to further strengthen hospitals health literacy responsiveness. Those explorative case studies give: – an overall positive signal about the feasibility of the V-HLO-fr – useful feedback to further formalize and refine its procedure of application.
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