Development of the Health Insurance Literacy Measure (HILM): Conceptualizing and Measuring Consumer Ability to Choose and Use Private Health Insurance

Abstract

Understanding health insurance is central to affording and accessing health care in the United States. Efforts to support consumers in making wise purchasing decisions and using health insurance to their advantage would benefit from the development of a valid and reliable measure to assess health insurance literacy. This article reports on the development of the Health Insurance Literacy Measure (HILM), a self-assessment measure of consumers' ability to select and use private health insurance. The authors developed a conceptual model of health insurance literacy based on formative research and stakeholder guidance. Survey items were drafted using the conceptual model as a guide then tested in two rounds of cognitive interviews. After a field test with 828 respondents, exploratory factor analysis revealed two HILM scales, choosing health insurance and using health insurance, each of which is divided into a confidence subscale and likelihood of behavior subscale. Correlations between the HILM scales and an objective measure of health insurance knowledge and skills were positive and statistically significant which supports the validity of the measure.

Acknowledgments and Funding

This research was funded by the Missouri Foundation for Health and the American Institutes for Research. The Health Insurance Literacy Roundtable led by Consumer's Union reaffirmed the need for health insurance literacy measure and provided an initial conceptual framework that served as the foundation for this research. We are grateful for the guidance provided by the Technical Expert Panel and the Health Insurance Literacy Stakeholder Group who provided guidance as we developed and tested the health insurance literacy measure.