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Am J Manag Care. 2008 Jun;14(6):369-76.

Comprehension and choice of a consumer-directed health plan: an experimental study.

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  • 1Department of Planning, Public Policy & Management, University of Oregon, Eugene, OR 97403-1209, USA.



To examine the extent to which numeracy predicts consumer-directed health plan (CDHP) comprehension and health plan choice. Also, to test whether comprehension can be improved using different presentation approaches.


We conducted an experimental laboratory study in which 303 adults viewed information about a hypothetical CDHP and a hypothetical preferred provider organization (PPO) presented in several different ways. Participants were randomized to view plan comparisons in a side-by-side or a common/unique format, and whether or not to view a framework.


Participants completed a survey that included comprehension items, numeracy and literacy assessments, and sociodemographics. Multivariate regression models were developed to examine the independent effects of numeracy and presentation approach on CDHP comprehension and choice. Interactions between numeracy and presentation approaches were tested.


Although less numerate consumers understood less about CDHPs, they were substantially more likely to select the CDHP. Providing an overarching framework to highlight the differences between the CDHP and PPO boosted comprehension on items related to the framework message. However, it reduced comprehension on items that were not related to the framework, particularly among the less numerate. Participants reported that the common/unique presentation of comparative information was easier to understand, yet there was a trend toward less comprehension using that presentation approach.


This study highlights the difficulty many consumers have in understanding comparative plan information and in making informed healthcare choices. Findings also indicate that some presentation strategies may help the less skilled understand choices better.

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