Health Insurance Literacy Among International College Students
A Qualitative Analysis
Keywords:health insurance literacy, international students
In this qualitative descriptive study, we examine health insurance literacy among a group of international college students. They were recruited from a public, co-educational Southeastern university in the United States during the fall semester of 2016 to participate in semistructured interviews. Data were gathered through a demographic questionnaire, two focus group discussions, and individual interviews. Interview sessions were audio-recorded, transcribed, and analyzed using a thematic analysis approach. Three themes emerged, including knowledge of health insurance options and benefits information, affordability, and unmet expectations. These findings show the need for higher education institutions to develop a plan to integrate international students into U.S. health care. International students are a vulnerable population; therefore, increasing health insurance literacy is vital to making an optimal health insurance choice, improving access to health care, and using health care efficiently. Future research should tailor educational interventions to mitigate poor health insurance literacy among international college students.
Adepoju, O., Mask, A., & McLeod, A. (2017). Health insurance literacy as a determinant of population health. Population Health Management, 21(2), 85–87.
Andrade, M. S. (2006). International students in English-speaking universities: Adjustment factors. Journal of Research in International Education, 5(2), 131–154.
Andrade, M. S. (2009). The effects of English language proficiency on adjustment to university life. International Multilingual Research Journal, 3(1), 16–34.
Baker, D. W. (2006). The meaning and the measure of health literacy. Journal of General Internal Medicine, 21(8), 878–883. https://doi.org/10.1111/j.1525-1497.2006.00540.x
Barnes, A. J., & Hanoch, Y. (2017). Knowledge and understanding of health insurance: challenges and remedies. Israel Journal of Health Policy Research, 6(1), 40–43. doi:10.1186/s13584-017-0163-2
Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J., & Crotty, K. (2011). Low health literacy and health outcomes: an updated systematic review. Annals of Internal Medicine, 155(2), 97–107.
Blumberg, L. J., Long, S. K., Kenney, G. M., & Goin, D. (2013). Public understanding of basic health insurance concepts on the eve of health reform. Urban Institute. http://hrms.urban.org/briefs/hrms_literacy.html?utm_source=iContact&utm_medium=email&utm_campaign=Health%20Policy%20Update&utm_content=Feb+2014-1st+Thur-newsletter
Burt, B. A., Knight, A., & Roberson, J. (2017). Racializing experiences of foreign-born and ethnically diverse black male engineering graduate students: Implications for student affairs practice, policy, and research. Journal of International Students, 7(4), 925–943.
Carmack, H. J., Bedi, S., & Heiss, S. N. (2016). International students, university health centers, and memorable messages about health. Journal of International Students, 6(1), 52–72.
Cheng, H.-I. (2004). Being ill in a foreign land: International students' perceptions of and experiences with university health services. Kaleidoscope: A Graduate Journal of Qualitative Communication Research, 3, 70–87
Collier, K. (2009). More state schools require health insurance for students. http://abcnews.go.com/Health/public-universities-require-healthinsurance-students/story?id=9228242.
Contreras-Aguirre, H. C., & Gonzalez Y Gonzalez, E. (2017). Experiences of international female students in U.S. graduate programs. College Student Journal, 51(1), 33–46.
Cornett, S. (2009). Assessing and addressing health literacy. Online Journal of Issues in Nursing, 14(3), 1–13.
Creswell, J. W. (2012).Qualitative inquiry and research design: Choosing among five approaches. Sage.
Doucette, Z. W. (2015). Student health benefits plan market research and analysis [Unpublished thesis, University of New Hampshire]. https://scholars.unh.edu/cgi/viewcontent.cgi?article=1226&context=honors
Egbert, N., & Nanna, K. M. (2009). Health literacy: Challenges and strategies. The Online Journal of Issues in Nursing, 14(3), 1–11
Gautam, C., Lowery, C. L., Mays, C., & Durant, D. (2016). Challenges for global learners: A qualitative study of the concerns and difficulties of international students. Journal of International Students, 6(2), 501–526.
Greenhalgh, T. (2015). Health literacy: Towards system level solutions. BMJ: British Medical Journal. doi:10.1136/bmj.h1026
Gele, A. A., Pettersen, K. S., Torheim, L. E., & Kumar, B. (2016). Health literacy: The missing link in improving the health of Somali immigrant women in Oslo. BMC Public Health, 16(1), 1–9.
Hansen, H. R., Shneyderman, Y., & Belcastro, P. A. (2015). Investigating the association of health literacy with health knowledge and health behavior outcomes in a sample of urban community college undergraduates. American Journal of Health Education, 46(5), 274–282.
Hyun, J., Quinn, B., Madon, T., & Lustig, S. (2007). Mental health need, awareness, and use of counseling services among international graduate students. Journal of American College Health, 56(2), 109–118.
Ickes, M. J., & Cottrell, R. (2010). Health literacy in college students. Journal of American College Health, 58(5), 491–498.
Institute of International Education. (2019). Project atlas. Retrieved January 20, 2020 from https://www.iie.org/en/Research-and-Insights/Project-Atlas
Jenny, L. (2017). Can better health insurance literacy reduce employer medical costs? Retrieved January 20, 2020 from https://www.hcwbenefits.com/can-better-health-insurance-literacy-reduce-employer-medical-costs/
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. https://doi.org/10.1111/fcsr.12034
Lee, J. J. (2015). Engaging international students. In S. J. Quaye & S. R. Harper (Eds.), Student engagement in higher education: Theoretical perspectives and practical approaches for diverse populations (pp. 105–120). Routledge.
Loewenstein, G., Friedman, J. Y., McGill, B., Ahmad, S., Linck, S., Sinkula, S., Beshears, J., Choi, J. J., Kolstad, J., Laibson, D. Madrian, B. C., List, J. A., & Volpp, K. G. (2013). Consumers’ misunderstanding of health insurance. Journal of Health Economics, 32(5), 850–862.
Long, S. K., & Goin, D. (2014). Large racial and ethnic differences in health insurance literacy signal need for targeted education and outreach. Health, 73(12.4), 14–16.
Mackert, M., Koh, H., Mabry-Flynn, A., Chaplin, S., & Beal, A. (2017). Domestic and international college students: Health insurance information seeking and use. Journal of International Students, 7(3), 542–554.
McClaran, D. M., & Sarris, R. A. (1985). International students and health: Their perceptions, behaviors and health care utilization [Technical Report]. Retrieved from https://files.eric.ed.gov/fulltext/ED257802.pdf
McIntosh, B. J., Compton, M. T., & Druss, B. G. (2012). Students left behind: The limitations of university-based health insurance for students with mental illnesses. Journal of American College Health, 60(8), 596–598.
Misra, R., & Castillo, L. G. (2004). Academic stress among college students: Comparison of American and international students. International Journal of Stress Management, 11(2), 132–149.
Mori, S. C. (2000). Addressing the mental health concerns of international students. Journal of Counseling & Development, 78(2), 137–144.
Morbidity and Mortality Weekly Report. (2010). Vital signs: Health insurance coverage and health care utilization—United States, 2006–2009 and January–March 2010. Morbidity and Mortality Weekly Report, 59(44), 1448–1454.
Nardin, R., Zallman, L., Sayah, A., & McCormick, D. (2016). Experiences applying for and understanding health insurance under Massachusetts health care reform. International Journal for Equity in Health, 15(1), 110–118. https://doi.org/10.1186/s12939-016-0397-6
Nobles, A. L., Curtis, B. A., Ngo, D. A., Vardell, E., & Holstege, C. P. (2018). Health insurance literacy: A mixed methods study of college students. Journal of American College Health, 67(5,) 469–478. doi:10.1080/07448481.2018.1486844
Paez, K. A., & Mallery, C. J. (2014). A little knowledge is a risky thing: Wide gap in what people think they know about health insurance and what they actually know. American Institutes for Research Issue Brief, 1-6. https://www.air.org/sites/default/files/Health%20Insurance%20Literacy%20brief_Oct%202014_amended.pdf
Paez, K. A., Mallery, C. J., Noel, H., Pugliese, C., McSorley, V. E., Lucado, J. L., & Ganachari, D. (2014). Development of the Health Insurance Literacy Measure (HILM): Conceptualizing and measuring consumer ability to choose and use private health insurance. Journal of Health Communication, 19(Suppl 2), 225–239.
Parragh, Z. A., & Okrent, D. (2015). Health literacy and health insurance literacy: Do consumers know what they are buying. Alliance for Health Reform. http://www.allhealthpolicy.org/wp-content/uploads/2017/01/Health-Literacy-Toolkit_163.pdf
Poyrazli, S., & Grahame, K. M. (2007). Barriers to adjustment: Needs of international students within a semi-urban campus community. Journal of Instructional Psychology, 34(1), 28-46.
Quincy, L. (2011). Making health insurance cost-sharing clear to consumers: challenges in implementing health reform’s insurance disclosure requirements. The Commonwealth Fund. http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2011/Feb/1480_ Quincy_making_hlt_ins_costsharing_clear_consumers_ib.pdf
Quincy, L. (2012). Measuring health insurance literacy: A call to action. Consumer’s Union. http://consumersunion.org/research/measuring-health-insurance-literacy-a-call-to-action/
QSR International. (2012). NVivo 10 [computer software].
Rootman, I., & Gordon-El-Bihbety, D. (2008). A vision for a health literate Canada. Canadian Public Health Association. https://www.researchgate.net/publication/237430726_A_Vision_for_a_Health_Literate_Canada
Saldaña, J. (2015). The coding manual for qualitative researchers. Sage.
Sharif, B. A. (1998). The forgotten world on campus: Acculturation and health issues of international students. Health Educator, 30(1), 11–18.
Sherry, M., Thomas, P., & Chui, W. H. (2010). International students: A vulnerable student population. Higher Education, 60(1), 33–46.
U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). National action plan to improve health literacy. https://health.gov/communication/initiatives/health-literacy-action-plan.asp
Ulrey, K. L., & Amason, P. (2001). Intercultural communication between patients and health care providers: An exploration of intercultural communication effectiveness, cultural sensitivity, stress, and anxiety. Journal of Health Communication, 13(4), 449–463.
Vorndran, K. (2015). International medical insurance for students studying at American universities [Blog post]. Tokio Marine HCC. https://www.hccmis.com/blog/insurance/international-medical-insurance-for-students-studying-at-american-universities/
Wu, H.-P., Garza, E., & Guzman, N. (2015). International student’s challenge and adjustment to college. Education Research International. https://doi.org/10.1155/2015/202753
Xiaoqiong, H. (2008). The culture shock that Asian students experience in immersion education. Changing English, 15(1), 101–105.
Yan, Z., & FitzPatrick, K. (2016). Acculturation and health behaviors among international students: A qualitative approach. Nursing & Health Sciences, 18(1), 58–63.
Zysberg, L. (2005). Nontraditional vulnerable populations: the case of international students. In Caring for the vulnerable (pp. 211–220). Jones and Bartlet.
How to Cite
All published articles are licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 4.0 Unported License.