Health insurance literacy and the associated factors in Iran: A national-scale study

Health insurance literacy (HIL) plays a vital role in individuals' ability to understand, select, and use health insurance services. Despite its significance, limited national-level research has been conducted in Iran.

A cross-sectional study was conducted from November 2024 to February 2025 with 1,625 beneficiaries of the Iranian Health Insurance Organization (IHIO). A validated researcher-developed questionnaire was used assessing the insured groups' knowledge, attitudes, information-seeking, utilization of services, digital and financial literacy and numeracy. Data were analyzed using t-tests, ANOVA, and multiple linear regression.

The mean HIL score was50.85 ± 20.41. Approximately 25.3% of the participants had low and 35.6% moderate HIL. Significant differences were observed across provinces. The variables associated with the HIL included gender, marital status, occupation, education level, insurance fund type, income, and age. The higher education, employment, and older age were positively associated with the higher HIL scores.

HIL allegedly plays an essential role in the informed healthcare decision-making and equitable service utilization. Disparities seemingly exist across the demographic and regional groups in terms of HIL. Therefore, the tailored educational programs, workplace training, and clearer insurance communication tools are recommended to improve the HIL and reduce inequalities in Iran's healthcare system.What is already known about the topic?Health insurance literacy (HIL), a subdomain of health literacy, is essential for informed decision-making and effective use of insurance benefits. Globally, inadequate HIL is linked to the delays in care, increased healthcare costs, and poor service utilization. In Iran, research on HIL has been limited to local studies or tool development, with no national-scale investigation addressing regional disparities or sociodemographic determinants.What does this study add to the literature?This is the first nationally representative study of HIL in Iran, covering over 1,625 individuals from diverse insurance funds and provinces. It revealed significant inequalities in HIL related to age, gender, education, employment, income, and geographic location-providing empirical evidence to inform the national health policy making.What are the policy implications?Findings underscore the need for targeted and equity-oriented HIL interventions. Policymakers should implement accessible public education campaigns, digital advisory platforms, and workplace-based training to improve HIL among vulnerable groups. Such strategies can support more informed insurance use and promote equitable access to healthcare.

Health literacy, defined as "the capacity of individuals to obtain, interpret, and understand basic health information and services needed to make appropriate health decisions," has garnered increasing attention in recent years [1]. The World Health Organization (WHO) recognizes health literacy as a major determinant of health in contemporary societies. It encompasses a set of cognitive and social skills that promote motivation and ability to access, understand, and use information to maintain and improve health [2].