OBJECTIVES: To measure health insurance literacy (HIL) of working-age cancer survivors (WACS) in the US and identify its sociodemographic and health insurance-related correlates.
METHODS: Data were collected from a national convenience sample of cancer survivors through an online survey from January to March 2022. Respondents were required to be aged 27-64 years and currently receiving/received cancer treatment within last five years. HIL was measured using the 21-item HIL Measure with four subscales: Confidence Choosing Health Plans (Confidence-CHP), Confidence Using Health Plans (Confidence-UHP), Comparing Health Plans (Compare-HP), and Proactive Use of Health Plans (Proactive-UHP). Correlates of HIL assessed included sociodemographic characteristics, financial skills (FS) (measured using the 5-item Financial Skills Scale), and health insurance challenges (HICs) experienced in past twelve months. Multivariable general linear models were used to evaluate associations between respondent characteristics and standardized HIL scores (i.e., Y-standardization).
RESULTS: The final sample had 309 WACS (median age: 52 years, 70.9% female, 80.9% White). With a possible range of 0-4, the mean (SD) overall HIL score was 2.83 (0.67). Mean (SD) subscale scores were: Confidence-CHP [2.48 (0.83)], Confidence-UHP [2.43 (0.94)], Compare-HP [3.35 (0.79)], and Proactive-UHP [3.06 (0.77)]. Younger age (27-40 years) was associated with lower HIL [estimate: -0.325, 95% confidence interval (CI): -0.579 to -0.071]. A majority (61.5%) of respondents reported experiencing ≥1 HIC. Most common HICs were difficulty seeking authorization for healthcare services/drugs (37.9%) and seeking information about covered services and insurance payments from health plans (32.0%). Past experience of HICs was associated with lower HIL [estimate: -0.266, 95% CI: -0.478 to -0.054], while FS scores were positively associated with HIL [estimate: 0.043, 95% CI: 0.035 to 0.051].
CONCLUSIONS: WACS demonstrated moderate HIL mainly driven by lower confidence regarding health plan selection and utilization. This finding highlights an interventional area for cancer patient empowerment and HIL education, especially among younger WACS in the US.
