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Skill, comprehension, and making an informed choice among health plans: An experimental study

Skill, comprehension, and making an informed choice among health plans: An experimental study. Ellen Peters, C.K. Mertz, and Judith H. Hibbard. Policy Challenge:.

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Skill, comprehension, and making an informed choice among health plans: An experimental study

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  1. Skill, comprehension, and making an informed choice among health plans: An experimental study Ellen Peters, C.K. Mertz, and Judith H. Hibbard

  2. Policy Challenge: • As the CDHP/ HSA high deductible plan designs are offered to a broader range of enrollees, will consumers with limited numeracy and literacy skills be able to comprehend their options and make an informed choice?

  3. Literacy: The Scope of the Challenge • 90 million Americans (47 percent) have limited literacy skills (Source: The National Adult Literacy Survey) • Even those with adequate literacy skills may be challenged by the complex literacy demands of the healthcare environment • selecting a health plan • adopting a healthy lifestyle • choosing providers • managing one's care • It’s a potential driver of healthcare costs (IOM, 1994)

  4. Health Literacy: What Is It? Health Literacy is the ability to read, understand and effectively use basic health-related information to make appropriate health care decisions.

  5. But health literacy should also be about HOW information is provided • Information can be easier or harder to evaluate • If it’s easier to evaluate, consumers and patients can comprehend and use that information more effectively in health choices (Hibbard & Peters, 2003; Hibbard, Slovic, Peters, & Finucane, 2002; Peters, Dieckmann, Dixon, Hibbard, & Mertz, in review; Peters, Lipkus, & Diefenbach, in press)

  6. Our study: Community sample (N=303) • 48% female • 76% white • Average age = 37; range = 18 to 64 years • Stratified on education in order to get range of ability • 49% <= high school degree or some trade school; • 51% some college or more

  7. Our study: Reading Literacy Measured with a short version of the Test of Functional Health Literacy (TOFHL) • We used only Passage B (Gazmararian et al., 1999)

  8. Our study: Numeracy • The ability to understand and use basic probability and mathematical concepts • Measured using scale from Lipkus, Samsa, & Rimer, 2001 • Plus additional items

  9. Experimental manipulations • Subjects see information about two health plans. • Plan A is a new HSA plan • Plan B is a more traditional plan • Six conditions • Long framework, information side-by-side • Short framework, information side-by-side • No framework, information side-by-side • Long framework, common and unique information • Short framework, common and unique information • No framework, common and unique information

  10. Benefits Summary, Usual format = Side-By-Side Comparison

  11. Benefits Summary, Common and Unique Comparisons

  12. Benefits Summary, Short Framework

  13. What we want to explain • Choice • Which health plan would you choose? (Plan A includes an HSA; Plan B is a more traditional plan) • Comprehension (Index = number correct of 6 items below) • Which plan is better for a person who needs a lot of health care? • Which plan is better for a person who needs very little health care? • Which plan has lower monthly premiums? • How much would it cost with Plan B to go to an Urgent Care Facility? • What would be the out-of-pocket maximum cost per year for a single person with individual coverage under Plan A? • What would be the out-of-pocket maximum cost per year for a single person with individual coverage under Plan B?

  14. Hypotheses • Comprehension will be lower for consumers with fewer literacy and numeracy skills • The framework will help consumers better comprehend the health plans • Providing common and unique information will help consumers better comprehend the health plans • This will be particularly true for individuals with lower skill levels

  15. Independent and strong impact of numeracy and literacy on comprehension • Comprehension = .35** Numeracy + .25** Literacy (R2=.28, F(2,295)=57.1, p<.0001)

  16. Less numerate comprehend less t(296)=7.6, p<.0001

  17. Despite understanding less, the less numerate chose HSA Plan A more often Chi-square (1, N=298)=6.8, p<.01

  18. With the usual format, most can identify lowest premiums.

  19. Low numerate cannot identify the best plan if you need a lot of health care

  20. Lack of comprehension is related to choices Chi-square (1, 51) = 5.5, p=.02

  21. Having information Side-by-side helped comprehension for both groups. High Numerate Low Numerate F(1,286)=4.7, p<.05

  22. Having a framework improved comprehension of the high numerate only High Numerate Low Numerate

  23. Conclusions • How information is presented influences comprehension • Side-by-Side presentations helped both groups • Providing a framework helps the high numerate • This is a difficult task for those with less skills • They choose the HSA plan more often • But understand less of the information • Deciding based on factors that they can understand – lower monthly premiums

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