Objectives: It is a widely perceived but poorly documented problem that many individuals lack clear understanding of health insurance. Librarians can address the unmet information needs that leave many unable to make appropriate health insurance choices. For those with lower levels of health insurance literacy, the ability to procure appropriate levels of health insurance coverage may be limited, which can have dire effects on individuals’ health statuses. Methods: This study employed semi-structured interviews to explore how newly hired employees at a large university in the southeastern United States understand health insurance concepts and make health insurance purchase decisions. This paper will offer examples of the information needs they described and an analysis of the trends across individuals. Results: Participants divulged a lack of understanding of insurance-related terminology (e.g., coinsurance). Their confidence in navigating the health insurance system decreased as education levels increased (i.e., those with a doctoral degree reported the lowest level of confidence in navigating health insurance enrollment). Participants also expressed difficulty in locating insurance information resources that were unbiased. These findings underscore an important role that librarians can play in providing access to unbiased, authoritative definitions of health insurance terms. Conclusion: The collected data form the foundation for the construction of a model of the health insurance decision-making process and offer insight to the library and information science community on how to support health insurance information needs. The proposed model and discussion demonstrate continued difficulty with understanding health insurance concepts and the factors which impact health insurance literacy and decision-making.

1. Emily Vardell, PhD
May 29, 2017
@evardell
Health Insurance Information Needs: How Librarians Can Help

2. health insurance literacy
“the extent to which consumers can make informed
purchase and use decisions”
(Kim, Braun, & Williams, 2013, p. 3)
2

3. What is the problem?
Quantitative research studies have shown that
individuals are often unable to select the most
financially appropriate health insurance coverage.
Most studies have employed experiments and/or
surveys, suggesting there may be a need to employ
other methods to create a broader picture of the
underlying factors.
3

4. Research Questions
How do people understand health insurance concepts?
How do individuals make their own health insurance decisions?
What are the factors that impact health insurance literacy and decision-
making?
4

5. Participants
Participants were recruited through the pool of new
employees who participate in benefits training from
the Human Resources Department at a large
university in the southeastern United States.
5

6. Study Design
• Demographic questionnaire
• Interviews
• Photographs of materials
• Health Insurance Literacy Measurement (HILM)*
6
*Paez, K.A., Mallery, C.J., Noel, H., Pugliese, C., McSorely, V.E., Lucado, J.L., & Ganachari, D. (2014). Development of the Health
Insurance Literacy Measure (HILM): Conceptualizing and Measuring Consumer Ability to Choose and Use Private Health Insurance.
Journal of Health Communication, 19(Supplement 2), 225-239.

7. Model of the Health Insurance Decision-Making Process
7

8. Obtain Overview
• Orientation session (n=21)
• Review printed materials (n=24)
• Review information on state
health plan website (n=16)
• Side-by-side plan comparison
chart (n=9)
• Coverage scenarios (n=9)
• Chart of monthly premiums (n=6)
8

9. Orientation Session
• Present the information in a
variety of formats to
accommodate multiple learning
styles
• Benefits officers should be
aware of the bias they may be
imparting
• "Psychologically reassuring" to
have in-person sessions
9

10. Information Tactics
• Comparing plans side-by-side (n=30)
• Reviewing costs (n=30)
• Calculating costs (n=18)
• Ignoring/Eliminating information (n=16)
• Avoiding Overthinking (n=9)
• Should have done more (n=4)
• Not a logical choice (n=4)
10

11. Information Tactics
• Comparing plans side-by-side
Continued use of online
calculators
• Eliminate/ignore information
Preferences for smaller size set
Interactive health materials where
users could hide irrelevant
information
11

12. Personal Reflection
• Past experience with health insurance (n=27)
• Forecasting needs for the next year (n=26)
• Forecasting worst case scenario/unknown (n=15)
• Reflecting on health status (n=16)
• Age as a factor (n=14)
• Reflecting on past year’s use of coverage (n=9)
12

13. Interpersonal Information Sources
13
Spouse/partner (n=13)
Colleague (n=12)
Parents (n=10)
Benefits officer (n=10)
Friends (n=8)
Other source (n=5)
• due to domain expertise, familiarity with available plans, and awareness of health care needs
• through a variety of media, including in person, by phone, through text, and via social media

14. Health Insurance Literacy
“Well I've never actually told someone what I'm doing right
now which is really good exercise and shows me that maybe I
should have done that. I'm not totally naïve when it comes to
trying to understand it. I guess I'm a little bit confused, what is
the difference between a coinsurance maximum and an out of
pocket maximum?” (P19)
14

15. HILM Scores
15

16. Outcomes
Provide better assistance with enrollment
16
ACA Navigators
Support process and provide access to quality
health insurance informational materials
Human resources officers
Librarians and information
professionals
Policy implications for funding information
assistance
Save large employers money with savvier
insurance purchasers

17. Possible Solutions
• Dictionary of insurance terminology
• Unbiased information sources
• One-on-one assistance
• Step-by-step enrollment instructions
• Ability to customize the information displayed in a comparison chart
17

18. Possible Solutions
• Dictionary of insurance terminology
• Unbiased information sources
• One-on-one assistance
• Step-by-step enrollment instructions
• Ability to customize the information displayed in a comparison chart
18

19. Know Your Health Insurance (MerckEngage®)
http://www.merckengage.com/knowyourhealthinsurance

20. My Health, My Voice
All available in English and Spanish:
A Woman’s Step-by-Step Guide to
Using Health Insurance
5 Steps to Using Your Health
Insurance Wisely
The 4 Kinds of Costs You May Pay
What is a Well-Woman Visit?
My Health, My Voice: My Personal
Health Journal
http://www.myhealthmyvoice.com/get-a-copy

21. Learn how to use your insurance card
From Coverage to Care (CMS)
• English (PDF, 7.2MB)
• Arabic / ‫ية‬ ‫عرب‬ ‫ال‬( PDF, 64KB)
• Chinese / 中文 (PDF, 145KB)
• Haitian Creole/Kreyòl Ayisyen (PDF,
58KB)
• Korean / 한국어 (PDF, 97KB)
• Russian / Русский (PDF, 63KB)
• Spanish / Español (PDF, 160KB)
• Vietnamese/TIẾNG VIỆT (PDF, 61KB)
http://www.cms.gov/About-CMS/Agency-Information/OMH/OMH-Coverage2Care.html

22. Acknowledgements
• Study participants
• Office of Human Resources
• Medical Library Association/ Thomson Reuters Doctoral Fellowship
22

23. Questions?
@evardell
emily.vardell@gmail.com

24. Extra Slides
24

25. Recruitment
Participant eligibility criteria:
employment at the university in the southeastern United
States
fluent in English
25
Introduction Methods Findings Discussion

26. Collect Data – Demographic Questionnaire
• Gender
• Age
• Racial/ethnic identity
• Education level
• Marital status
• Family status
• Job title
26
Introduction Methods Findings Discussion

27. Participants’ Characteristics (n=30)
• 80% of participants were female and 20% male.
• 46.67% of participants were between 27-35 years old, 20% 18-26 years
old, 20% 36-45 years old, 10% 46-55 years old, and 3.33% 56-64 years
old.
• 63.33 % of participants were White/Caucasian, 13.33% Black/African
American, 13.33% Asian or Asian American, 6.67% Hispanic/Latino, and
3.33% American Indian.
• 43.33% of participants had a Master's degree, 36.67% had a Bachelor's
degree, 13.33% had a Doctoral degree, and 6.67% had some college.
• 56.67% of participants were single, 36.67% were married, and 6.67%
had a domestic partner.
27

28. Collect Data – Interviews
Broad, Opening Questions (e.g., reflecting on choice(s))
Micro-Moment Time-Line Interview
Semi-Structured Interview Questions about the Decision-Making
Process (e.g., preferred option desired characteristics)
Questions Design to Gauge Direct Change to Individual following the
Affordable Care Act (e.g., changes in the last 5 years)
Questions about Health Insurance Materials (e.g., most helpful and
least helpful information provided)
Wrap-Up (e.g., compare with other purchases)
28
Introduction Methods Findings Discussion

29. Collect Data – Health Insurance Literacy
Measurement (HILM)
Choosing a Health Plan
Scale 1: Confidence
How confident are you that… Not at all
confident
Slightly
confident
Moderately
confident
Very
confident
1. You understand health
insurance terms?
2. You know where to find the
information you need to choose
a health plan if you were not
offered insurance through an
employer?
3. You know how to estimate
what you have to pay for your
health care needs in the next
year, not including emergencies?
4. You know where to go for help
if you were having trouble
affording health insurance
outside an employer?
5. You know what questions to
ask so you can choose the best
health plan for you?
6. You would choose the health
plan that is best for you?
Choosing a Health Plan
Scale 2: Behavior
29
When comparing health
insurance plans, how likely are
you to…
Not at all
confident
Slightly
confident
Moderately
confident
Very
confident
1. Understand how the plans
differ?
2. Find out if you have to meet a
deductible for health care
services? A deductible is the
amount of money you have to
pay before your health insurance
will pay anything for your health
care.
3. Look to see which doctors and
hospitals are covered in each
plan?
4. Understand what you have to
pay for prescription drugs?
5. Understand what you would
have to pay for emergency
department visits?
6. Understand what you would
have to pay for specialist visits?
Introduction Methods Findings Discussion

30. Step 4. Analyze Data – Process
30
Micro-Moment
Time-Lines
Coding
Interviews
Analysis
• Hand coded individually
• Codes = participants’ words
• Compared w/ info seeking & use models
• Reviewed Integrated Framework
Memos
Introduction Methods Findings Discussion
• Identified strategies and sources

31. Trustworthiness/Reliability
• Constant-comparison method of content analysis
• Transcripts were coded individually by inductive reasoning,
allowing themes to emerge
• After identifying more than 62 individual codes, identified
connections between the codes to develop larger themes
• Wrote reflective memos
• Documented the research process in detail
31
Introduction Methods Findings Discussion