Health insurance literacy in the Netherlands: The translation and validation of the United States’ Health Insurance Literacy Measure (HILM)

Holst, Laurens; Victoor, Aafke; Brabers, A.; Rademakers, Jany; Jong, Judith de

doi:10.1371/journal.pone.0273996

Cited by 6 publications

(3 citation statements)

References 14 publications

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“…In total, 880 respondents filled in the questionnaire (59%), 32 (4%) of whom partly filled in the questionnaire (Table 1 ). This is in line with previous panel response rates [ 34 , 38 , 39 ], and on the high end 2 for CV studies [ 40 ]. Relative to the full sample, fewer people aged 18–39 completed the questionnaire (25% vs 34%), with corresponding effects on education and income.…”

Section: Resultssupporting

confidence: 91%

Should Commercial Diagnostic Testing Be Stimulated or Discouraged? Analyzing Willingness-to-Pay and Market Externalities of Three Commercial Diagnostic Tests in The Netherlands

Stadhouders,

van Vliet,

Brabers

et al. 2023

Appl Health Econ Health Policy

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Introduction Consumers may purchase commercial diagnostic tests (CDT) without prior doctor consultation. This paper analyzes three CDT markets—commercial cholesterol tests (CCT), direct-to-consumer genetic health tests (DGT) and total body scans (TBS)—in the context of the universal, collectively financed health care system of the Netherlands. Methods An online willingness-to-pay (WTP) questionnaire was sent to a representative sample of 1500 Dutch consumers. Using contingent valuation (CV) methodology, an array of bids for three self-tests were presented to the respondents. The results were extrapolated to the Dutch population and compared to current prices and follow-up medical utilization, allowing analysis from a societal perspective. Results Overall, 880 of 1500 respondents completed the questionnaire (response rate 59%). Of the respondents, 26–44% were willing to pay a positive amount for the CDT. Willingness-to-pay was correlated to age and household income, but not to health status or prior experience with these tests. At mean current prices of €29 for CCT, €229 for DGT and €1,650 for TBS, 3.3%, 2.5%, and 1.1%, were willing to purchase a CCT, DGT, and TBS, respectively. All three CDT resulted in net costs to the health system, estimated at €5, €16, and €44 per test, respectively. Reducing volumes by 90,000 CCTs (19%), 19,000 DGTs (5%) and 4,000 TBSs (2.5%) in 2019 would optimize welfare. Conclusion Most respondents were unwilling to consume CDT at any price or only if the CDT were provided for free. However, for a small group of consumers, societal costs exceed private benefits. Therefore, CDT regulation could provide small welfare gains. Supplementary Information The online version contains supplementary material available at 10.1007/s40258-023-00846-0.

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Section: Resultssupporting

confidence: 91%

Should Commercial Diagnostic Testing Be Stimulated or Discouraged? Analyzing Willingness-to-Pay and Market Externalities of Three Commercial Diagnostic Tests in The Netherlands

Stadhouders,

van Vliet,

Brabers

et al. 2023

Appl Health Econ Health Policy

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“…Future research is therefore warranted to propose a single method for classifying and comparing HIL scores internationally. 7 , 31 …”

Section: Discussionmentioning

confidence: 99%

Assessing health insurance literacy in Switzerland: first results from a measurement tool

Bardy

2023

European Journal of Public Health

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Background Health insurance literacy (HIL) is crucial for individuals to make informed-decisions and navigate complex choice-based health insurance systems. However, there is a lack of evidence on HIL in countries outside the US, with Switzerland no exception. Methods Using the HILM-CH, a survey instrument developed to measure HIL in Switzerland, this study first describes the answers to the HILM-CH. Second, the study uses ordinary least squares and quantile regressions to investigate the associations between the HIL score and demographic, socioeconomic, health, and preference factors in the German, French, and Italian Swiss regions. Results A third of the population faces difficulties in finding health insurance information. Understanding it and managing the financial aspects of the Swiss health insurance system pose the biggest barriers to the population. The HIL score significantly and positively correlates with age and financial risk, while non-Swiss individuals have lower HIL scores. No association was found between HIL, gender, education and time preference. There is a small health gradient, with more doctor visits associated with higher HIL in the lowest quantiles of the HIL score. Similarly, wealthier individuals in the Swiss German part of Switzerland have a higher HIL when choosing their health insurance. Conclusion This study provides important insights into Swiss HIL and its associated factors. These findings contribute to the international literature on HIL and highlight the importance of understanding variations in HIL and various factors in choice-based health insurance systems.

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“…The HILM-NL questionnaire, the Dutch version of the original US Health Insurance Literacy Measure [ 34 ], which has been translated and validated in Dutch according to the WHO guidelines for translation and adaption of instruments [ 33 ], was also part of Nivel’s ‘switching health insurer’ monitor in February 2020. The HILM-NL questionnaire has proven to be a valid and reliable instrument [ 35 ]. The measure is publicly available on the Nivel website: https://www.nivel.nl/nl/publicatie/health-insurance-literacy-measurement-nederlands-hilm-nl .…”

Section: Methodsmentioning

confidence: 99%

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

Holst,

Brabers,

Rademakers

et al. 2023

BMC Health Serv Res

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In several countries, citizens are expected to be critical consumers when choosing a health insurance policy. However, there are indications that citizens do not always have the sufficient skills, so called health insurance literacy (HIL), to do this. We investigated 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. We obtained information by sending questionnaires to members of the Nivel Dutch Health Care Consumer Panel in 2020. Of the 1,500 approached, 806 panel members participated (response rate 54%). Our results indicate that, compared to those with a high HIL, respondents with a low HIL more often find choosing a health insurance policy difficult, not interesting, and boring, and less often consider it important and worthwhile. Furthermore, they make less use of the opportunity to switch from one health insurer to another. However, they do still opt for a supplementary insurance policy and a voluntary deductible to the same extent as citizens with a high HIL. We conclude that the HIL level among Dutch citizens is related to the way in which they experience the process of choosing a health insurance policy and to the extent to which they switch from one insurer to another. But it is not related to their health insurance choices. Follow-up research should focus on how citizens with a low HIL can be better supported when choosing a health insurance policy.

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Health insurance literacy in the Netherlands: The translation and validation of the United States’ Health Insurance Literacy Measure (HILM)

Cited by 6 publications

References 14 publications

Should Commercial Diagnostic Testing Be Stimulated or Discouraged? Analyzing Willingness-to-Pay and Market Externalities of Three Commercial Diagnostic Tests in The Netherlands

Should Commercial Diagnostic Testing Be Stimulated or Discouraged? Analyzing Willingness-to-Pay and Market Externalities of Three Commercial Diagnostic Tests in The Netherlands

Assessing health insurance literacy in Switzerland: first results from a measurement tool

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

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