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

1. 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

2. In today’s session, we’ll discuss
o An overview of health insurance literacy
o Commonly used readability tests
o Research on the reading levels of health
insurance forms
o The tools that can be used (by librarians and
others) to assess reading levels
o What can be done to lower the reading level of
materials

3. 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.

4. 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-

5. 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-

6. 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-

7. 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.

8. Does this look familiar?

9. 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.

10. 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.

11. 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

13. Examples

14. Examples

15. Affordable Care Act
(ACA/Obamacare)
Readability
FORCAST
11.1
Gunning Fog
9
New DaleChall
7-8

16. Company
Administering
Insurance Company
Number of
Pages
FORCAST Test
FORCAST Test
(grade level)
(without common
ins. words)
Aerostructures
Manufacturer
Architecture Firm
Aetna
4
13.4
13.0
UnitedHealthCare
Midwestern regional
health system
Self-administered
2
2
13.9
10.9
13.1
9.9
Large, Southern public
university
BlueCross/ BlueShield
North 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/ BlueShield
Illinois
½
11.8
11.2
1
12.6
12.3
National, natural foods UnitedHealthCare
supermarket chain

17. Oleander Readability Studio
Readability Studio [computer program]. Version 1.2.0.0.

18. Oleander Readability Studio
http://www.oleandersolutions.com/readabili
tystudioorder.html
Readability Studio [computer program]. Version 1.2.0.0.

19. Oleander Readability Studio
(with Language Options)
http://www.oleandersolutions.com/ReadabilityStudioL
Readability Studio anguagePackOrder.html
[computer program]. Version 1.2.0.0.

20. Oleander Readability Studio
http://www.oleandersolutions.com/Readabil
ityStudioFeatures.html
Readability Studio [computer program]. Version 1.2.0.0.

21. Readability Studio: Difficult Words

22. Read-able.com

23. Testing MedlinePlus

24. Read-able.com

25. ReadabilityFormulas.com
http://www.readabilityformulas.com/

26. 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-readabilityHP010354286.aspx#_Toc342546555

27. Microsoft Word (2010)

28. 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.

29. How to Adapt Your Materials
 Monosyllabic words
 Short sentence length
 Minimum number of sentences and complex words
 Lessen number of unfamiliar words
Perhaps add:
 Increase the amount of white space
 Use clear fonts; avoid italics and other hard to read
features
Readability Studio [computer program]. Version 1.2.0.0.

30. In today’s session, we’ve
discussed
An overview of health insurance literacy
Commonly used readability tests
Research on the reading levels of health
insurance forms
The tools that can be used (by librarians and
others) to assess reading levels
What can be done to lower the reading level of
materials

31. Questions?
Emily Vardell, MLS
evardell@unc.edu