Studying user interactions with health insurance decision aids

Emma Bland

Authors:  Dr. Wayne Giang, Dr. Michelle Alvarado, Coralys Colon Morales

Faculty Mentor: Dr. Wayne Giang

College:  Herbert Wertheim College of Engineering


Two barriers to effective enrollment decisions are low health insurance literacy and lack of knowledge about how to choose a plan. To remedy these issues, digital decision-aids have been used to increase health insurance knowledge and guide the decision process. One example are Virtual Benefits Counselors (VBC) that mimic guidance given by an in-person Human Resources (HR) counselor. The goal of this study is to compare enrollment decisions made using the guided information provided by VBC decision aids and self-directed information provided on HR websites. In an experimental study, participants were asked to make a hypothetical enrollment decision using either the VBC or HR website. The Health Insurance Literacy Measure (HILM) was administered before and after interaction with the system. We also measured participants’ level of comfort with their decision (SURE) and perceptions of system usability (SUS). Post-interaction HILM scores were higher, but differences did not depend on the systems. Participants with higher post-HILM scores were less conflicted about their decision, and this was not dependent on the system used. The VBC users had higher SUS scores. These results suggest that both systems may have benefits, but higher system usability may not necessarily lead to more confident enrollment decisions.

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9 Responses
  1. Grace Taylor

    Hey Emma!

    Great poster, I was wondering how you designed the guided VBC? Were there any alternative VBC designs you were considering and would test in the future?

  2. Emma Bland

    Hi Grace, thanks for your question!

    We did not design the VBC in question, it was designed by a 3rd party company called Jellyvision, Inc. Some other researchers have designed their own decision aids, most notably Politi et al. called “Show Me My Health Plan” that aims to simplify terminology, assess preferences, and provide personalized estimations. We are currently not planning on testing other VBCs, but potentially participants with different demographics to see how those demographics play a role in VBC efficacy.

  3. Wayne Giang

    Hi Emma, great job with the poster. Are there any takeaways about consumer information seeking strategies that might be applicable for improving public awareness of COVID-19 medical information?

    1. Emma Bland

      Hi Wayne,

      Through our retrospective think-aloud sessions we found that typically consumers liked information that was specific to them (i.e. personalized recommendations), easy to compare (e.g. comparison charts), and easy to understand. Some takeaways from these findings could be to target specific demographics and areas with simple, easy to understand directives on how to protect themselves from COVID-19.

  4. Jeffrey Chen

    Hey Emma,

    Great poster. You stated the pre and post knowledge test scores were relatively similar among the two different systems. Where there any questions that the participants tended to do better or worse on depending on the system they used?

    1. Emma Bland

      Hi Jeffrey, thanks for your question!

      While I have not looked into any specific question scores getting affected by the system, in general participants tended to struggle with terms such as ‘co-insurance’ or ‘co-pay’ vs more traditional health insurance terms such as ‘deductible’ or ‘premium’. Participants seemed to benefit from any sort of interaction with a system, and we didn’t find any significant difference due to the VBC or the website on the socres.

  5. Haolan Zheng

    Hi Emma, your poster looks fantastic! You really did a great job!
    In terms of your conclusions, why do you think you failed to find out any difference between VBC and the Website? If you could, what kind of improvement you want to make in VBC (Alex in this condition) to truly improve the literacy or confidence compared to the traditional websites?

    1. Emma Bland

      Hi Haolan, thanks for your question!

      I think one of the reasons we failed to find any difference is due to the small sample size, therefore our analysis did not have strong statistical power. Additionally, our participants currently have insurance and have had insurance for the past year at least, which are factors that lead to higher health insurance literacy. Given they had higher literacy, their gains were likely to be limited on the VBC, and future research should look into the effect of VBCs on lower literacy consumers were they are likely to have more benefits.

      Some improvements that I think could be made to Alex to improve literacy or confidence is a terms index, more breakdowns as to wear costs come from, and more detailed plan information in general. These were common complaints we heard during the think aloud from the VBC users.

  6. Boyi Hu

    Very informative! For me selecting different insurance policy packages is always like buying lottery,