Health insurance literacy: How best to measure and does it matter to health care access and affordability?

Background: Health insurance is complex, cost are continuously rising, and people are assuming more of these costs. Health insurance literacy (HIL) is related to healthcare access, yet there is no agreement about how best to measure HIL.

Objectives: Contrast two HIL measures.

Assessing DIF among small samples with separate calibration t and Mantel-Haenszel χ² statistics in the Rasch model.

The National Council Licensure Examination (NCLEX) program has evaluated differential item functioning (DIF) using the Mantel-Haenszel (M-H) chi-square statistic. Since a Rasch model is assumed, DIF implies a difference in item difficulty between a reference group, e.g.