Can Health Literacy Boost Health Services Utilization in the Context of Expanded Access to Health Insurance?
Can Health Literacy Boost Health Services Utilization in the Context of Expanded Access to Health Insurance?
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DOI：
10.1177/1090198119875998
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发表时间：
2019-10-08
影响因子：
4.2
通讯作者：
Kawachi, Ichiro
中科院分区：
文献类型：
--
作者：
Kino, Shiho;Kawachi, Ichiro
背景。获得医疗保险和卫生知识普及是“赋能资源”以鼓励接受服务的关键组成部分。我们试图测试在《平价医疗法案》（Affordable Care Act）扩大医疗保险覆盖面的背景下，健康素养是否能促进医疗服务的利用。方法。我们使用了2016年行为风险因素监测系统中包含的11个州的个人层面数据。我们进行了两阶段最小二乘工具变量分析。我们通过《平价医疗法案》（Affordable Care Act）扩大医疗补助计划（Medicaid），改善了获得医疗保险的机会。作为结果变量，我们检查了费用作为获得所需护理的障碍，有私人医生，接受常规健康检查，流感疫苗，巴氏涂片检查，乳房x光检查，乙状结肠镜检查/结肠镜检查，以及过去一年的牙科检查。然后，我们测试了改善健康保险获取和卫生服务利用之间的关系是否受到健康素养的调节。健康素养是通过一个包含三个项目的二分量表来衡量的：难以获得有关健康的建议或信息，难以理解来自卫生专业人员的信息，以及难以理解书面健康信息。结果。我们发现，改善医疗保险的获取增加了报告私人医生的可能性，同时减少了报告成本作为护理障碍的可能性。我们还发现健康保险和健康素养对牙科就诊有交互作用。然而，在预防服务利用方面，保险获取与健康素养之间没有显著的相互作用。结论。卫生知识普及并不能解释为什么人们即使获得了保险也不能获得预防服务，唯一可能的例外是高知识普及的个人去看牙医。
Background. Health insurance access and health literacy are critical components of "enabling resources" to encourage uptake of services. We sought to test whether health literacy boosts health services utilization in the context of expanded access to health insurance stemming from the Affordable Care Act. Method. We used individual-level data from 11 states included in the Behavioral Risk Factor Surveillance System 2016. We conducted a two-stage least squares instrumental variables analysis. We instrumented improved access to health insurance stemming from Affordable Care Act Medicaid expansion. As outcome variables, we examined cost as a barrier to needed care, having a personal doctor and receipt of routine health checkups, flu shots, Pap tests, mammograms, sigmoidoscopy/colonoscopy, and dental visits in the past year. We then tested whether the relation between improved health insurance access and health services utilization was moderated by health literacy. Health literacy was measured by a dichotomized scale comprising three items: difficulties obtaining advice or information about health, difficulties understating information from health professionals, and difficulties understanding written health information. Results. We found that improving health insurance access increased the likelihood of reporting a personal doctor while reducing the likelihood of reporting cost as a barrier to care. We also found an interaction effect between health insurance and health literacy on dental visits. However, there was no significant interaction effect between insurance access and health literacy for preventive services utilization. Conclusion. Health literacy did not explain why people fail to access preventive services even when they obtain access to insurance, with the sole possible exception of dental visits among individuals with high literacy.