"Pick a Plan and Roll the Dice": A qualitative study of consumer experiences selecting a health plan in the non-group market.
"Pick a Plan and Roll the Dice": A qualitative study of consumer experiences selecting a health plan in the non-group market.
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《选一个计划，掷骰子》：一项关于消费者在非团体市场中选择医保计划的体验的定性研究
DOI：
10.1016/j.hpopen.2023.100112
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发表时间：
2023-12-15
影响因子：
--
通讯作者：
Galbraith, Alison A.
中科院分区：
文献类型：
--
作者：
Faugno, Elena;Gilkey, Melissa B.;Cripps, Lauren A.;Sinaiko, Anna;Peltz, Alon;Kingsdale, Jon;Galbraith, Alison A.
关键词：
我们采访了36名在非团体保险计划方面有负面经历的美国成年人。
参与者表示在选择保险计划时面临巨大挑战。
障碍包括理解关键术语、查找信息以及比较计划。
非团体保险计划的消费者希望得到定制的决策支持。
对于无法获得雇主赞助或公共保险的消费者来说，非团体（个人）保险市场中不符合消费者需求的健康计划选择可能会对健康和财务状况产生负面的后续影响。
这项定性访谈研究旨在了解那些后来对所选计划有负面体验的消费者在选择非团体健康计划时的经历和挑战。
我们对来自三个州的一家大型地区性健康保险公司的36名参与者进行了半结构化电话访谈，这些参与者是有目的选取的样本，他们于2017年参加了非团体计划（21人参加了《平价医疗法案》（ACA）市场计划，15人在市场外参保）。如果参与者在参保后报告使用其计划时有负面体验，例如医疗费用高于预期，则将其纳入研究。访谈探讨了选择计划时面临的挑战；选择所需的信息；现有工具的有用性；以及改善计划选择体验的干预措施的首选形式。我们使用主题内容分析方法对访谈记录进行了分析。
研究参与者报告在选择保险计划时面临巨大挑战。关键障碍包括理解保险术语、查找相关信息以及在不同计划之间进行比较。参与者在使用市场网站时重视在不同承保公司之间进行比较的能力，但对客户服务不太满意。改进建议包括提高计划和语言的标准化程度以及提供定制的一对一援助。
这项研究的结果表明，非团体市场中的健康计划选择给消费者带来了挑战，可以通过参保援助和改进信息呈现方式来解决这些问题。提供个性化的援助以查找和选择保险范围可能会导致计划选择更符合消费者需求，并提高在后续参保期间选择计划的信心。
We interviewed 36 US adults with negative experiences with non-group insurance plans. Participants reported facing substantial challenges to choosing an insurance plan. Barriers included understanding key terms, finding information, and comparing plans. Consumers of non-group insurance plans desire customized decision support. For consumers without access to employer-sponsored or public insurance, health plan choices in the non-group (individual) insurance market that do not meet consumer needs have the potential for negative downstream implications for health and financial well-being. This qualitative interview study sought to understand consumers’ experiences and challenges with choosing a non-group health plan, among those who later had negative experiences with the plan they chose. We conducted semi-structured telephone interviews with a purposive sample of 36 participants from a large regional health insurance carrier in three states who enrolled in non-group plans in 2017 (21 in Affordable Care Act (ACA) Marketplace plans and 15 enrolled off-Marketplace). Participants were included if they reported negative experiences using their plan after enrollment, such as higher-than-expected medical costs. Interviews explored challenges choosing a plan; information needed for choosing; usefulness of available tools; and preferred format for interventions to improve plan choice experiences. We analyzed interview transcripts using thematic content analysis. Study participants reported experiencing substantial challenges to choosing an insurance plan. Key barriers included understanding insurance terms, finding relevant information, and making comparisons across plans. Participants valued the ability to make comparisons across carriers when using the Marketplace websites but were less satisfied with customer service. Suggestions for improvement included greater standardization of plans and language and availability of customized one-on-one assistance. Findings from this study suggest that health plan selection in the non-group market presents challenges to consumers that may be addressed through enrollment assistance and improved presentation of information. Personalized assistance to find and choose coverage may lead to plan choices that better meet consumer needs and increase confidence choosing a plan in subsequent enrollment periods.
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