By Madoka Kumamaru, IVI Summer Intern and Graduate Student at the Columbia School of Public Health

Five years ago, when I was a teenager with a chronic health condition returning to the United States for university, I encountered several challenges while navigating the healthcare system. Although some of my peers had coverage until age 26 through their family’s insurance plan or utilized limited student insurance designed to support international students or those without family insurance, I required more comprehensive coverage and had few options. Due to my lack of financial income and health condition, I explored the Medicaid insurance marketplace to find a plan that matched my requirements.

Even as someone committed to improving the U.S. healthcare system, I needed support understanding the forms, requirements, and jargon. Complex to understand and even more challenging to navigate, the U.S. health insurance system presents barriers that limit healthcare accessibility. With 51% of Americans reporting inadequate health insurance literacy, measured by knowledge of basic insurance terms and the use of health insurance, the financial and emotional burden of seeking and obtaining health insurance is exacerbated (Edward et al). According to a JAMA study, 29.6% of study participants reported having delayed or foregone care due to cost  in the 12 months of the study (Tipirneni et al). Additional barriers, like language, transportation, and time spent on the insurance marketplace, can worsen costs and health outcomes.

In the recent Economic Impacts report, the Innovation and Value Initiative and AcademyHealth investigated similar, and often invisible, healthcare costs.  The Economic Impacts Framework outlines a social impacts domain, which includes “economic impacts that may have less obvious measures, but have downstream impacts like time spent negotiating with insurance companies, compounding financial impacts (such as ability or inability to obtain insurance), or access to social services,” as well as an ability to work, which includes “adequacy or inadequacy of health insurance coverage.”

While navigating the healthcare system, numerous questions arise. For instance, how can I obtain health insurance? What is a health insurance marketplace? Which insurance plan would be best for my healthcare needs? Once I have insurance, how can I schedule an appointment with “in-network” healthcare providers? What are deductibles, premiums, copayments, and out-of-pocket costs? Without clear answers to these questions or support to navigate the system, the costs to the patient add up.

My interactions with the healthcare insurance system continue to evolve – I relocated to a different state. Still, there are barriers at every turn that complicate the system, and without anyone to answer my questions, I am left to figure out the intricacies on my own. Based on my experience, I firmly believe that improving literacy is crucial for overcoming various challenges such as time constraints, lack of internet access, or language barriers.

Resource List


About IVI
The Innovation and Value Initiative (IVI) is a 501(c)(3) tax-exempt, non-profit research organization dedicated to advancing the science and improving the practice of health technology assessment through development of novel methods and the creation and application of enhanced health technology assessment models to support local decision-making needs in healthcare.

Contact: Smita Sanwardeker
Phone: 267.909.7661