Evaluating Communication and Health Insurance Exchanges

August 25, 2014

The new federal health-care law will give 52 million more Americans access to medical insurance. However, choosing the right coverage – a daunting task for most people – could be even more difficult for those who have never had health insurance, new research suggests.

Hurdles include understanding unfamiliar terms that are necessary to compare and choose among the available plans, and a lack of clear, simple explanations from trusted sources.

“We need to do a better job communicating information about health insurance to help people make the choices that work best for them.”

Mary Politi is collaborating with Institute for Public Health scholars Matthew Kreuter, Timothy McBride and Kimberly Kaphingst, along with Enbal Shacham from Saint Louis University, on a project to evaluate communication strategies to help individuals make decisions about the health insurance exchange options that will be part of the Affordable Care Act. The group is looking at various approaches – including plain language, visual approaches and personal narratives – to find out what is most effective at improving individuals’ decisions.

Professor, Department of Surgery, School of Medicine

“Selecting the best health-insurance option can be confusing, even for people who have gone through the process for many years,” says Mary Politi, PhD, an assistant professor of surgery and the study’s leader. “We need to do a better job communicating information about health insurance to help people make the choices that work best for them.”

Their qualitative study is one of the first to examine how well people who have never had health insurance understand health insurance. In the first part of their study, they examined understanding of key insurance terms among 51 uninsured Missourians from rural, urban and suburban parts of the state. They found that coinsurance, deductible, out-of-pocket maximum, prior authorization and formulary were among the most difficult terms for study participants.

While many of the participants had never heard of key insurance terms, those who have had experience with auto insurance were more familiar with the word deductible, and those who have had past experience with health insurance understood more terms than those who had never had health insurance. But even some who had previous experience with health insurance confused the meaning of similar terms, such as urgent care and emergency care or coinsurance and copayment.

The researchers are now applying the findings to test ways to improve communication about health insurance and the health insurance exchanges the federal government and states are establishing as part of the new health-care law in a randomized study of over 200 uninsured individuals.

“Findings from this study will be especially important for individuals with limited health literacy and math skills given the complex written and numerical information required to understand plan differences,” Politi says.


Mary Politi, School of Medicine
Kimberly Kaphingst, School of Medicine
Matthew Kreuter, Brown School
Timothy McBride, Brown School
Enbal Shacham, Saint Louis University

More Information

Knowledge of Health Insurance Details Among the Uninsured in Medical Care Research and Review

Scholars pinpoint gaps in consumer knowledge of health insurance jargon in the St. Louis Beacon