Association of Health Insurance Literacy with Health Care Utilization: a Systematic Review

Abstract

Background Given increasing numbers of people experiencing transitions in health insurance due to declines in employer-sponsored insurance and changes in health policy, the understanding and application of health insurance terms and concepts (health insurance literacy) may be important for navigating use of health care. The study objective was to systematically review evidence on the relationship between health insurance literacy and health care utilization. Methods Medline, SCOPUS, Web of Science, CINAHL, PsychInfo, Cochrane Library, and reference lists of published literature were searched in August 2019. Quantitative, qualitative, and intervention studies that assessed the association of health insurance literacy as the exposure and health care utilization as the outcome were identified, without language or date restrictions. Outcomes were independently assessed by 2–3 reviewers. Results Twenty-one studies including a total of 62,416 subjects met inclusion criteria: three interventional trials, two mixed-methods studies, and sixteen cross-sectional studies. Ten of thirteen preventive care studies suggested that higher health insurance literacy was associated with greater utilization of primary care and other preventive services. Eight of nine studies of care avoidance demonstrated that individuals with lower health insurance literacy were more likely to delay or avoid care. A few studies had mixed results regarding the utilization of emergency department, inpatient, and surgical care. Discussion The emerging literature in this area suggests that health insurance literacy is an important factor that can enable effective utilization of health care, including primary care and preventive services. However, the literature is limited by a paucity of studies using validated tools that broadly measure health insurance literacy (rather than testing knowledge of specific covered services). Improving health insurance literacy of the general public and increasing plain language communication of health insurance plan features at the point of health care navigation may encourage more effective and cost-conscious utilization. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-06819-0.

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“… 6 7 People with a poor understanding of health insurance benefits are more likely to delay or forgo healthcare. 5 8 Low health insurance literacy is common across a wide range of countries, 9 and has been found to be particularly concentrated among those with lower education and incomes, 10 11 and among the elderly. 7 …”

“…Accountability in health systems is critical to enable citizens to understand and participate in decisions about which health services are provided, how much they will cost and how to access them, which can ultimately contribute to improving service efficiency and quality 3. Health insurance benefits that are not easy to understand and use erode the value of health coverage, as evidenced in both high-income countries such as the USA,4 5 as well as low or middle-income countries such as Senegal and India 6 7. People with a poor understanding of health insurance benefits are more likely to delay or forgo healthcare 5 8.…”

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