Insuring Good Health: Outcomes and Acceptability of a Participatory Health Insurance Literacy Intervention in Diverse Urban Communities

Abstract

Background. The U.S. uninsured rate has dropped significantly since the passage of the Affordable Care Act (ACA), yet insurance coverage remains lower in historically marginalized communities than in the overall population. New consumer engagement approaches that involve these populations are needed. The purpose of this study was to evaluate the effectiveness of the Insuring Good Health Intervention, a website and video series designed to improve engagement with health insurance and ACA reforms. The study was designed and implemented using a community-based participatory research approach. Method. We conducted a lagged-control cluster randomized controlled trial to evaluate Insuring Good Health with racially and ethnically diverse adults seeking services in medically underserved areas within the Detroit, Michigan metropolitan area. Outcomes were assessed at baseline and at 6 and 9 months postintervention, and including self-efficacy, knowledge, beliefs, and intention to seek help with insurance navigation and care. Results. Among 243 participants, mean age was 43.4 (SD = 13) years, and all participants met federal guidelines for poverty. The study had an 86% response rate at 9-month follow-up (n = 209). Compared with the lagged-control group, intervention participants had more positive beliefs concerning preventive care (estimate 0.51, standard error 0.16; p < .01), and intention to seek help with insurance navigation and care (estimate 0.43, standard error 0.17; p < .001) at 9-month follow-up. Hispanic participants benefitted the most from the intervention, including improved knowledge of health insurance eligibility over 9 months compared with other racial/ethnic groups (estimate −0.97, standard error 0.40, p < .01). Discussion. Insuring Good Health was associated with increased intention to seek help with insurance navigation and care, and improved beliefs around preventive care. Conclusions. Insuring Good Health has the potential to be an important consumer engagement tool to reduce disparities in health insurance coverage and care seeking.

Evaluating a novel online behavioural intervention to encourage cost-conscious strategies among US adults with chronic conditions who are enrolled in a high-deductible health plan: a proof-of-concept pilot study

“… 32 Another study in the metropolitan Detroit area evaluated an online intervention comprised of a website and video series called ‘Insuring Good Health’, which aimed to promote engagement with health insurance. 33 The website is primarily focused on providing information on insurance enrolment. It defines common insurance terminology such as premiums, but does not mention HDHPs or discuss specific cost-conscious strategies.…”

“…However, the intervention did not significantly increase health insurance literacy or confidence in navigating one’s health plan. 33 Our intervention is the first to our knowledge which provides information on multiple cost-conscious strategies for HDHP enrollees in a structured set of educational modules.…”

Digital Solutions to Improve Health Insurance Literacy

“…Given the complexity that exists in the American healthcare system today, there is a clear opportunity to leverage digital platforms to elevate and promote health insurance literacy. Patel et al found the use of a website and video series featuring relatable characters overcoming common challenges and meeting personal goals in health situations resulted in stronger intention to seek help with health insurance navigation in racial and ethnic minorities [9]. The federal government has already created resources aimed at educating consumers about health insurance, such as the CMS Coverage to Care website [10].…”

Medicare for All: A Health Insurance Literacy Perspective

“…Along the way, health education and promotion specialists can advance health insurance literacy by developing and delivering educational programs through academic extension programs, adult education venues, and public health outreach settings. Such programs, albeit on a limited scale, have shown promise in increasing individual-level knowledge and skills and improving the capacity to make optimal health insurance purchases ( Brown et al, 2016 ; Brown, 2018 ; Patel et al, 2019 ).…”