The role of health insurance literacy in the process and outcomes of choosing an insurance policy

BACKGROUND: Several countries have healthcare systems that require their citizens to make informed and thoughtful decisions about which health insurance policy fits their needs and preferences best. There are indications that citizens do not always have sufficient skills, so called health insurance literacy (HIL), to do this. This can lead to citizens being sub-optimally insured, suffering inadequate coverage and facing unexpected costs. This study aims to investigate whether the level of HIL among Dutch citizens is related to the way in which they experience the process of choosing a policy, and furthermore whether it is related to their health insurance choices. METHODS: A mixed-mode questionnaires was distributed to 1,500 participants of the Nivel Dutch Health Care Consumer Panel in February 2020. The response rate was 54% (n = 806). Regression analyses were performed to gain a better understanding of the association of HIL with the process and outcomes regarding the choice of a health insurance policy. RESULTS: Respondents with a low HIL, in comparison to those with a high HIL, find choosing a health insurance policy more often difficult, not interesting, and boring, and less often consider it important and worthwhile (p < 0.01 for all). Also, they make less use of their opportunity to switch from one health insurer to another (p < 0.05). However, they do opt for a supplementary insurance policy and a voluntary deductible to the same extent as respondents with a high HIL. CONCLUSIONS: The level of HIL among Dutch citizens is related to the way they experience the process of choosing a health insurance policy, and to the extent to which they switch from one health insurer to another, but not to their health insurance choices. It is important to get a better understanding of the barriers citizens with a low HIL experience during this process, and of their needs and preferences. KEY MESSAGES: • The level of HIL is related to the way Dutch citizens experience the process of choosing a health insurance policy. • Compared to those with a high HIL, Dutch citizens with a low HIL switch health insurers less often, but opt for a supplementary policy and a voluntary deductible to the same extent.