PS3-20 HEALTH INSURANCE DECISION-MAKING OF INDIVIDUALS WITH CHRONIC CONDITIONS

Tuesday, October 20, 2015
Grand Ballroom EH (Hyatt Regency St. Louis at the Arch)
Poster Board # PS3-20

Ashley Housten, OTD, OTR/L, MSCI, MPA, Washington University School of Medicine, Saint Louis, MO, Kimberly Kaphingst, ScD, UNIVERSITY OF UTAH, DEPARTMENT OF COMMUNICATION, Salt Lake City, UT, Timothy McBride, PhD, Washington University in St Louis, Brown School of Social Work, St Louis, MO, Jingxia (Esther) Liu, PhD, Washington University School of Medicine Division of Biostatistics, Saint Louis, MO and Mary Politi, PhD, Washington University School of Medicine, St. Louis, MO
Purpose: To investigate how uninsured or recently insured individuals with chronic conditions make decisions about health insurance. 

Methods: Cross-sectional data were analyzed from 343 uninsured or recently insured individuals from rural and urban community health settings; data were part of a larger randomized trial on health insurance decision making among the uninsured. Demographic characteristics were collected. We assessed how the presence and number of chronic conditions among adults and children in the household impacts decision making, including (1) health insurance knowledge, (2) health insurance preferences (3) health insurance plan choices and (4) decisional conflict after viewing and selecting hypothetical health insurance plan options. 

Results: Two hundred fifty-one (73%) participants reported having a chronic condition or living with an adult with a chronic condition. 97 (28%) reported a child with a chronic condition in their household. The majority of participants who reported having a chronic condition present in their household, for either an adult (93%) or child (87%), were the primary health insurance decision maker in their household. The number of chronic conditions reported for a child had a significant positive relationship to health insurance knowledge (p<0.03) and plan preference (p<0.03). Adults with chronic conditions differed significantly in health insurance preferences compared to those without chronic conditions (p<0.001); they indicated valuing physician choice and quality more strongly than those without chronic conditions. Reporting a chronic condition status among adults (p=0.28) or children (p=0.79) in one’s household was not significantly related to decisional conflict about health insurance decision making. Education and White race had a significant positive association with health insurance knowledge (p<0.001; p<0.001, respectively) and health insurance preference (p=0.025; p<0.001, respectively).

Conclusion: Individuals with chronic conditions may be more actively attending to all features of health insurance, such as physician choice and quality, and not solely to plan premium. This differs from our prior findings for the uninsured population overall who attend mainly to the cost of the premium. These issues have implications for the way we communicate about health insurance to those new to insurance through the ACA.

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