Can Gamification Teach Young People How Health Insurance Works?

The health insurance market remains a confusing place for many Americans, and young Americans in particular. In studies, young adults have displayed inconsistent knowledge of health insurance terminology, and they are also the demographic most likely to be uninsured. In 2015, 14.4% of 18 to 24 year olds did not have health insurance, topped only by 17.9% of 25 to 34 year olds.

In a new study, researchers from the University of North Texas proposed a potentially novel solution to the problem: gamification. More than half of Americans play video games, the authors wrote, making “digital and Web-based games…a reasonable and strategic platform to engage with these audiences.”

To test the theory, they created a game called “Healthcare America,” a newsgame that made use of interactive narrative to test and inform knowledge of health insurance in young adults. Users played as a health information advocacy worker who had to help people with their personal health insurance challenges. The game designers developed scenarios through a collaboration with journalism students, and the information was pulled from health insurance websites like Healthcare.gov.

The researchers measured Healthcare America's success by participants' ability to define each of the following terms, before and after playing the game:

• the Affordable Care Act
• deductible
• monthly premium
• referral
• in-network provider
• co-payment
• out-of-pocket maximum
• coinsurance
• health maintenance organization (HMO)
• preferred provider organization (PPO)

In total, 72 students played the game for a one-hour session and completed a survey of the terms before and after. Students were also asked to appraise their confidence in their healthcare knowledge on a 5-point scale.

There was a modest bump in overall confidence, from a mean of 3.38 pregame to 3.76 postgame. When it came to defining terms, however, the students were inconsistent. Significantly more participants gave correct definitions of “in-network provider,” “referral,” and “monthly premium” after playing the game: all 3 saw gains of 20% or more correct. But those were the only terms that more than 50% of students correctly defined, even after playing the game. Many major concepts, like “the Affordable Care Act” and “co-insurance” remained undefinable by 60% or more of students, and the number of correct responses even fell postgame for both “co-payment” and “out-of-pocket maximum.”

The study authors attributed the discrepancy between increased confidence and lukewarm improvement to the way that understanding was measured. They wrote that providing a definition was “significantly more challenging” for students than demonstrating that they could make a decision involving that term.

The team from the University of North Texas remained confident in their hypothesis that a game could help inform young Americans about health insurance. The playing sessions were singular and brief, and they argued that repeated play may improve results. Audio cues and narration, they suggested, could increase engagement, and Healthcare America could be built into a cohesive suite of games that students could play at different points throughout their college education to prepare for the market ahead.

The authors called the health insurance newsgame “an appropriate initial step to decreasing these health-related challenges,” that could be improved over time. Mixed as the results may be, a game has more potential to improve health insurance literacy than waiting around for healthcare to get less confusing.

The study, “Breaking Health Insurance Knowledge Barriers Through Games: Pilot Test of Health Care America,” was published recently in the Journal of Medical Research Serious Games.