A Randomized Trial Examining Three Strategies for Supporting Health Insurance Decisions among the Uninsured
A Randomized Trial Examining Three Strategies for Supporting Health Insurance Decisions among the Uninsured
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DOI：
10.1177/0272989x15578635
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发表时间：
2016-10-01
影响因子：
3.6
通讯作者：
McBride, Timothy
中科院分区：
文献类型：
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作者：
Politi, Mary C.;Kaphingst, Kimberly A.;McBride, Timothy
背景《平价医疗法案》允许没有保险的个人从众多私人计划中选择医疗保险，这是一个具有挑战性的决策过程。本研究旨在探讨策略的有效性，以支持医疗保险的决定之间的无保险。方法.来自城市、郊区和农村地区的参与者（N = 343）被随机分配到3种条件中的一种：1）简单的语言表; 2）视觉条件，参与者选择查看什么信息以及顺序; 3）叙述条件。我们管理的措施评估知识（真/假的反应健康保险的关键功能），选择的信心（决策冲突量表的不确定性分量表），满意度（项目从健康信息全国趋势调查），偏好的保险功能（测量李克特规模从根本不重要的非常重要），和计划的选择。结果虽然我们没有发现在知识，选择的信心，或不同条件的满意度显着差异，不同条件的参与者作出价值一致的选择，选择计划，符合他们的偏好的关键保险功能。此外，根据《成人医学知识快速评估简表》衡量，（REALM-SF）总体知识水平较高（x = 6.1v.4.8，P < 0.001），且偏好于直观语言表（P = 0.04）和视觉叙述（P = 0.0002）条件，而那些健康素养技能不足的人没有表现出对研究条件的偏好。对于那些具有较高主观计算能力和较高与较低教育程度的健康保险知识的人，也出现了类似的模式。收入较高的人对自己的选择信心较低（mml：mover accent= x= 28.7 v. 10.0，其中数字越高表示信心越低/不确定性越大; P = 0.004）。结论.那些开发有关健康保险市场的材料以支持健康保险决策的人可以考虑从简单的语言表格开始，在上下文中介绍健康保险术语，并根据未投保人可能使用和评估保险功能的方式组织信息。健康知识和算术技能有限的人以及教育程度较低的人面临着选择健康保险和权衡成本和覆盖面之间的独特挑战。
Background. The Affordable Care Act allows uninsured individuals to select health insurance from numerous private plans, a challenging decision-making process. This study examined the effectiveness of strategies to support health insurance decisions among the uninsured. Methods. Participants (N = 343) from urban, suburban, and rural areas were randomized to 1 of 3 conditions: 1) a plain language table; 2) a visual condition where participants chose what information to view and in what order; and 3) a narrative condition. We administered measures assessing knowledge (true/false responses about key features of health insurance), confidence in choices (uncertainty subscale of the Decisional Conflict Scale), satisfaction (items from the Health Information National Trends Survey), preferences for insurance features (measured on a Likert scale from not at all important to very important), and plan choice. Results. Although we did not find significant differences in knowledge, confidence in choice, or satisfaction across condition, participants across conditions made value-consistent choices, selecting plans that aligned with their preferences for key insurance features. In addition, those with adequate health literacy skills as measured by the Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF) had higher knowledge overall (x = 6.1 v. 4.8, P < 0.001) and preferred the plain language table to the visual (P = 0.04) and visual to narrative (P = 0.0002) conditions, while those with inadequate health literacy skills showed no preference for study condition. A similar pattern was seen for those with higher subjective numeracy skills and higher versus lower education with regard to health insurance knowledge. Individuals with higher income felt less confident in their choices (mml:mover accent= x= 28.7 v. 10.0, where higher numbers indicate less confidence/more uncertainty; P = 0.004). Conclusions. Those developing materials about the health insurance marketplace to support health insurance decisions might consider starting with plain language tables, presenting health insurance terminology in context, and organizing information according to ways the uninsured might use and value insurance features. Individuals with limited health literacy and numeracy skills and those with lower education face unique challenges selecting health insurance and weighing tradeoffs between cost and coverage.