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Exploring health insurance literacy in the Netherlands: citizens’ skills and needs in choosing a health insurance policy.

Holst, L. Exploring health insurance literacy in the Netherlands: citizens’ skills and needs in choosing a health insurance policy. Utrecht: Nivel, 2025. 161 p.
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The Dutch health insurance system functions under the assumption that all citizens are able to make well-informed decisions with regard to their health insurance policy. However, there are several indications suggesting that this is not the case in practice. Nevertheless, the role of citizens in the health insurance system has received relatively little attention in research. Therefore, the objective of this thesis was to gain insight into how citizens in the Netherlands choose a health insurance policy, what barriers they face during the selection process of a health insurance policy, and what their specific needs and preferences are regarding information and support.

A central concept in this thesis is health insurance literacy (HIL). HIL can be defined as: 'the extent to which insured can make informed purchase and use decisions regarding health insurances'. In order to get insight into the level of HIL of citizens in the Netherlands, we translated the Health Insurance Literacy Measure (HILM) that was developed in the US into Dutch and adapt it to the Dutch situation. This resulted in the HILM-NL, a reliable instrument for measuring HIL among citizens in the Netherlands.

To achieve our objective, several research questions were addressed. The data presented in this thesis were gathered using questionnaires and semi-structured interviews with members of the Nivel Dutch Health Care Consumer Panel (DHCCP).
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