SUPPORTING DECISIONS ABOUT HEALTH INSURANCE TO IMPROVE CARE FOR THE UNINSURED

描述(由申请人提供)：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有资格通过允许他们从多个医疗保险计划中进行选择的交换系统获得保险。没有保险的个人收入低得不成比例，更有可能患有未经治疗或管理不善的慢性健康状况。ACA的目标是改善未参保者的机会，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医疗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，对于几乎没有这项任务经验的个人来说，做出知情的健康计划选择是具有挑战性的。如果不了解计划信息，个人就不太可能做出既满足其财务需求又满足其健康需求的明智选择。这可能会对他们支付医疗费用以管理和改善健康状况的能力产生重大影响。我们过去的研究是第一次调查目前未参保的个人对健康保险的理解以及对他们的保险决策至关重要的因素。利用我们对未参保个人的研究信息，纳入关键政策利益相关者的反馈，并在传播学、健康素养和决策科学的最佳实践的基础上，我们制定了改善医疗保险计划决策的策略。我们目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战略。我们将在线编写一个决策支持工具，这样我们就可以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，我们将收集利益相关者对采用和实施该工具的可能性的反馈。随着规则和条例的制定以及医疗保险交易所的更新，我们将使用本提案中开发的信息，为州和联邦一级的医疗改革实施提供信息。未来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.