The Measurement of Health Insurance Literacy

The measurement of health insurance literacy varies across studies. Many studies utilize objective knowledge-based questions on key insurance concepts (e.g., premium, deductible, co-pay, provider networks) through true/false statements, definitions, and/or multiple choice questions [6,8,14,15,25]. Other studies have utilized subjective measures such as rating an individual’s level of confidence in understanding health insurance terms [5] or a limited number of questions from the HILM [3]. However, no consistent number of questions or cut-off points for defining adequate HIL is available across studies. In contrast, HILM, despite its limitations, represents a multi-dimensional measure that captures multiple domains of health insurance literacy. The only other study to our knowledge that utilizes scales 1 and 2 of the HILM is one where HIL is assessed pre and post an intervention aiming to enhance HIL [26]. Question scores for most of the statements were lower for our sample compared to the 83% White, non-Hispanic sample in the other study.

Few studies specifically examined the relationship between ACA knowledge and HIL. Among the few that did, similar findings were reported where familiarity of the marketplace was positively associated with health insurance literacy [3].

The positive relationship between income levels and ACA knowledge is consistent with other studies where ACA knowledge and HIL were higher among higher income brackets [8]. The finding that a diabetes diagnosis was associated with higher

likelihood of at least some ACA knowledge may reflect unmet healthcare needs among this group, thus, generating more interest in seeking information about healthcare coverage options. It might also indicate more experience with the healthcare system.