SUPPORTING DECISIONS ABOUT HEALTH INSURANCE TO IMPROVE CARE FOR THE UNINSURED

由于患者保护和平价医疗法案（ACA）的通过，5200万没有医疗保险的美国人通过交换系统获得保险资格，该系统允许他们从多个医疗保险计划中选择。没有保险的人收入低得不成比例，更有可能患上未经治疗或管理不善的慢性病。ACA的一个目标是改善无保险者的获得，降低他们的自付费用，并通过更好地预防和管理慢性病来改善健康。只有当个人了解如何选择和使用健康保险来满足他们的财务和健康需求时，这些目标才能实现。然而，做出明智的健康计划选择是具有挑战性的个人与此任务的经验很少。如果不了解计划信息，个人就不可能做出既能满足其财务需求又能满足其健康需求的知情选择。这可能会严重影响他们支付护理费用以管理和改善其健康的能力。我们过去的研究是第一个检查目前没有保险的个人对健康保险的理解和对他们的保险决策重要的因素之一。利用我们对未投保个人的研究信息，结合关键政策利益相关者的反馈，并建立在传播科学，健康素养和决策科学的最佳实践基础上，我们制定了改善健康保险计划决策的策略。我们当前的提案旨在通过额外的利益相关者投入和我们过去关于最成功的决策支持方法的研究结果来更新这些策略。我们将在线编制一个决策支持工具，以便我们能够根据用户的需求和偏好定制信息。接下来，我们将在随机实验中测试我们更新的决策支持工具的有效性。最后，我们将收集利益攸关方对采用和实施该工具的可能性的反馈意见。我们将利用本提案中开发的信息，为州和联邦层面的卫生改革实施提供信息，因为规则和法规正在编写，医疗保险交易所正在更新。今后的传播和实施研究还将比较向公众提供这一工具的战略。

DESCRIPTION (provided by applicant): As a result of the passage of the Patient Protection and Affordable Care Act (ACA), 52 million Americans without health insurance became eligible for insurance through an exchange system that allows them to choose from multiple health insurance plans. Uninsured individuals are disproportionately low-income, and are more likely to suffer from untreated or poorly managed chronic health conditions. A goal of the ACA is to improve access for the uninsured, lower their out-of-pocket costs, and improve health through better prevention and management of chronic conditions. These goals will only be achieved if individuals understand how to select and use health insurance to meet their financial and health needs. However, making an informed health plan choice is challenging for individuals with little prior experience with this task. Without understanding plan information, individuals are unlikely to make an informed choice that meets both their financial and health needs. This could substantially impact their ability to pay for care to manage and improve their health. Our past research was one of the first to examine currently uninsured individuals' understanding of health insurance and factors important to their insurance decision making. Using information from our study of uninsured individuals, incorporating feedback from key policy stakeholders, and building on best practices in communication science, health literacy, and decision science, we developed strategies to improve decision making about health insurance plans. Our current proposal aims to update these strategies through additional stakeholder input and our past research findings about most successful decision support approaches. We will program a decision support tool online so we can tailor information to users' needs and preferences. Next, we will test the efficacy of our updated decision support tool in a randomized experiment. Finally, we will collect stakeholders' feedback on likelihood of adoption and implementation of the tool. We will use the information developed in this proposal to inform health reform implementation at the state and federal levels, as rules and regulations are written and health insurance exchanges are updated. A future dissemination and implementation study will also compare strategies for delivering this tool to the public.