A new JAMA Network study found that lower health insurance literacy could be connected to people avoiding healthcare services, including preventive care.
The report suggested that clinicians, payers and policymakers should communicate coverage concepts more clearly to improve health insurance literacy, including what are considered free preventive services.
Nearly one-third of participants delayed or avoided care owing to cost over the past year, according to the survey.
Poor health literacy can cause confusion and care avoidance as well as worsen health status. It can also lead to higher healthcare costs down the road.
This is especially problematic for minorities, the previously uninsured, the elderly and people with low socioeconomic status. Patients face a combination of literacy challenges in the healthcare system, which can result in people avoiding needed care or not knowing where to turn for affordable, high-quality care.
The online survey of 506 adults with health coverage found that high health insurance literacy is connected to a lower likelihood of delayed or foregone care connected to cost. The survey asked about preventive services like cholesterol level checks, colon cancer screen tests and mammograms.
It found that 16% of respondents avoided preventive services over the past year. That includes 10.5% who didn't get a physical exam that is guaranteed in the Affordable Care Act. For non-preventive care, 10% avoided an urgent care visit. The researchers also found high-deductible health plans caused people to avoid healthcare.
The survey also found a connection between health literacy and income. Those with lower health literacy were less likely to use preventive services.
"These findings suggest that health insurance literacy is important for patients, not only while selecting a health plan, but also in healthcare navigation and uptake of recommended health services," the report said.
The authors wrote that people with low health insurance literacy might not understand cost-sharing and cost-reduction features, and ACA coverage mandates that means they won't owe out-of-pocket costs or copays.
Many payers, providers and other healthcare stakeholders understand the importance of health literacy. A 2017 UnitedHealthcare survey found that only 9% of Americans surveyed "showed an understanding" of four basic health insurance terms: health plan premium, health plan deductible, out-of-pocket maximum and co-insurance. In good news, that result was two percentage points better than 2015, but it still shows healthcare has a long way to go to educate members and patients.
Multiple initiatives are working on the task. Cigna recently launched an Amazon Alexa "skill" that hopes to improve consumer health literacy. Mayo Clinic last year created an Alexa program to give basic first aid advice.