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An Overview of Health Insurance Literacy Emily Vardell, MLS PhD Student and Teaching Fellow School of Information and Library Science UNC Chapel Hill February 20, 2014

An Overview of Health Insurance Literacy

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This presentation discusses: -Research on the readability of health insurance forms -Reading level assessment tools -Best practices for lowering the reading level of materials

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Page 1: An Overview of Health Insurance Literacy

An Overview of

Health Insurance Literacy

Emily Vardell, MLSPhD Student and Teaching Fellow

School of Information and Library Science UNC Chapel Hill

February 20, 2014

Page 2: An Overview of Health Insurance Literacy

In today’s session, we’ll discuss

o An overview of health insurance literacyo Commonly used readability testso Research on the reading levels of health

insurance formso The tools that can be used (by librarians and

others) to assess reading levelso What can be done to lower the reading level of

materials

Page 3: An Overview of Health Insurance Literacy

Health Literacy

“the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions”

Ratzen, S. C., & Parker, R. M. (2000). Introduction. In: Selden, C. R., Zovn, M., Ratzen, S. C., & Parker, R. H. (Eds.), National Library of Medicine current bibliographies in medicine: Health literacy. NLM Pub N. CBM 2000-1. Bethesda, MD. National Institutes of Health, U.S. Department of Health and Human Services.

Page 4: An Overview of Health Insurance Literacy

Health Literacy Categories• Below Basic indicates no more than the most simple

and concrete literacy skills.• Basic indicates skills necessary to perform simple and

everyday literacy activities.• Intermediate indicates skills necessary to perform

moderately challenging literacy activities.• Proficient indicates skills necessary to perform more

complex and challenging literacy activities.

Kutner, M., Greenburg, E., Jin, Y., & Paulsen, C. (2006). The health literacy of America's adults: Results from the 2003 National Assessment of Adult Literacy. NCES 2006-483. National Center for Education Statistics.

Page 5: An Overview of Health Insurance Literacy

Text

Kutner, M., Greenburg, E., Jin, Y., & Paulsen, C. (2006). The health literacy of America's adults: Results from the 2003 National Assessment of Adult Literacy. NCES 2006-483. National Center for Education Statistics.

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Health Literacy Level by Health Insurance Coverage

Kutner, M., Greenburg, E., Jin, Y., & Paulsen, C. (2006). The health literacy of America's adults: Results from the 2003 National Assessment of Adult Literacy. NCES 2006-483. National Center for Education Statistics.

Page 7: An Overview of Health Insurance Literacy

Health Insurance Literacy

“a new concept that addresses the extent to which consumers can make informed purchase and use decisions”“knowledge, ability, and confidence to effectively choose and use health insurance”

Kim, J., Braun, B., & Williams, A. D. (2013). Understanding Health Insurance Literacy: A Literature Review. Family and Consumer Sciences Research Journal, 42(1), 3-13.

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Does this look familiar?

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Readability Tests• FORCAST - only test not designed for running narrative,

grade level based on number of monosyllabic words• Flesch-Kincaid - grade level based on sentence length

and syllable count• Gunning Fog – grade level based on number of

sentences and complex words• New Dale-Chall - grade level based on sentence length

and number of unfamiliar words

Readability Studio [computer program]. Version 1.2.0.0. Vandalia, Oh: Oleander Software, Ltd; 2013.

Page 10: An Overview of Health Insurance Literacy

Reading level of Medicaid renewal applications

• 45 states had reading level guidelines • 24 (52.2%) of the states failed to meet their own

guidelines • 41 states (89.1%) failed the Flesch-Kincaid Grade

Level Index• None (0%) of the assessments passed the

FORCAST

Pati, S., Kavanagh, J. E., Bhatt, S. K., Wong, A. T., Noonan, K., & Cnaan, A. (2012). Reading level of Medicaid renewal applications. Academic pediatrics, 12(4), 297–301.

Page 11: An Overview of Health Insurance Literacy

Assessment of Children’s Public Health Insurance Program enrollment applications

• A more holistic assessment of CHIP applications that assessed reading demands, layout characteristics, and document complexity through:– Lexile Analyzer (to assess reading demands)

• Reading Level = sentence length and word frequency– The User-Friendliness Tool (to assess layout)

• Font size; avoidance of capital letters, italics, and specialty fonts; use of ample white space; short paragraph lengths

– The PMOSE/IKIRSCH scale (to assess document complexity)• Complexity of structure (use of lists) and density (number of labels and items on

the list)

Wallace, L. S., DeVoe, J. E., & Hansen, J. S. (2011). Assessment of Children’s Public Health Insurance Program enrollment applications: a health literacy perspective. Journal of pediatric health care : official publication of National Association of Pediatric Nurse Associates & Practitioners, 25(2), 133–7.

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•Collect•Assess –Oleander Readability Studio

•Compare

Page 13: An Overview of Health Insurance Literacy

Examples

Page 14: An Overview of Health Insurance Literacy

Examples

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Affordable Care Act (ACA/Obamacare)

Readability

FORCAST

11.1

Gunning Fog

9

New Dale-Chall7-8

Page 16: An Overview of Health Insurance Literacy

Company Administering Insurance Company

Number of Pages

FORCAST Test (grade level)

FORCAST Test (without common ins. words)

Aerostructures Manufacturer

Aetna 4 13.4 13.0Architecture Firm UnitedHealthCare 2 13.9 13.1Midwestern regional health system

Self-administered 2 10.9 9.9

Large, Southern public university

BlueCross/ BlueShieldNorth Carolina

8 13.4 13.2

Large, Midwestern public university

Medica 4 13.6 13.4

Large, Mid-Atlantic public university

Self-administered 5 12.5 12.4

National cable company

UnitedHealthCare and BlueCross/BlueShield

11 12.6 12.2

National pharmacy chain

BlueCross/ BlueShieldIllinois

½ 11.8 11.2

National, natural foods supermarket chain

UnitedHealthCare 1 12.6 12.3

Page 17: An Overview of Health Insurance Literacy

Oleander Readability Studio

Readability Studio [computer program]. Version 1.2.0.0. Vandalia, Oh: Oleander Software, Ltd; 2013.

Page 18: An Overview of Health Insurance Literacy

Oleander Readability Studio

Readability Studio [computer program]. Version 1.2.0.0. Vandalia, Oh: Oleander Software, Ltd; 2013.

http://www.oleandersolutions.com/readabilitystudioorder.html

Page 19: An Overview of Health Insurance Literacy

Oleander Readability Studio (with Language Options)

Readability Studio [computer program]. Version 1.2.0.0. Vandalia, Oh: Oleander Software, Ltd; 2013.

http://www.oleandersolutions.com/ReadabilityStudioLanguagePackOrder.html

Page 20: An Overview of Health Insurance Literacy

Oleander Readability Studio

Readability Studio [computer program]. Version 1.2.0.0. Vandalia, Oh: Oleander Software, Ltd; 2013.

http://www.oleandersolutions.com/ReadabilityStudioFeatures.html

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Readability Studio: Difficult Words

Page 22: An Overview of Health Insurance Literacy

Read-able.com

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Testing MedlinePlus

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Read-able.com

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ReadabilityFormulas.com

http://www.readabilityformulas.com/

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Microsoft Word (2010)1. Click the File tab, and then click

Options.2. Click Proofing.3. Under When correcting spelling and

grammar in Word, make sure the Check grammar with spelling check box is selected.

4. Select Show readability statistics.After you enable this feature, open a file that you want to check, and check the spelling. When Outlook or Word finishes checking the spelling and grammar, it displays information about the reading level of the document.

http://office.microsoft.com/en-us/word-help/test-your-document-s-readability-HP010354286.aspx#_Toc342546555

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Microsoft Word (2010)

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How to Adapt Your Materials• FORCAST - only test not designed for running

narrative, grade level based on number of monosyllabic words

• Flesch-Kincaid - grade level based on sentence length and syllable count

• Gunning Fog – grade level based on number of sentences and complex words

• New Dale-Chall - grade level based on sentence length and number of unfamiliar words

Readability Studio [computer program]. Version 1.2.0.0. Vandalia, Oh: Oleander Software, Ltd; 2013.

Page 29: An Overview of Health Insurance Literacy

How to Adapt Your MaterialsMonosyllabic wordsShort sentence lengthMinimum number of sentences and complex words Lessen number of unfamiliar wordsPerhaps add: Increase the amount of white spaceUse clear fonts; avoid italics and other hard to read

features

Readability Studio [computer program]. Version 1.2.0.0. Vandalia, Oh: Oleander Software, Ltd; 2013.

Page 30: An Overview of Health Insurance Literacy

In today’s session, we’ve discussed

An overview of health insurance literacyCommonly used readability testsResearch on the reading levels of health

insurance formsThe tools that can be used (by librarians and

others) to assess reading levelsWhat can be done to lower the reading level of

materials

Page 31: An Overview of Health Insurance Literacy

Questions?

Emily Vardell, [email protected]