Health insurance literacy in Israel: gaps between knowledge and use in a universal healthcare system

Background: Health Insurance Literacy (HIL) is critical for navigating healthcare systems and making informed insurance decisions. In Israel, which has a universal system with voluntary insurance, disparities in HIL may contribute to inequitable access. This study assessed HIL among diverse Israeli groups using a validated, culturally adapted, multidimensional tool. Methods: A nationally stratified sample of Hebrew-speaking and Arabic-speaking Israeli adults (1,012) completed an online cross-sectional survey in September 2024. A 75-item questionnaire combined an adapted Health Insurance Literacy Measure (HILM), self-reported assessments, and objective knowledge tests. Analyses (ANOVA, regression) examined relationships between demographics and HIL dimensions. Results: HIL levels were moderate (mean HILM score: 2.39/4), with significant disparities across demographic groups. Non-Ultra-Orthodox Israeli-born Jews showed the highest literacy, while Arab and foreign-born Jews displayed lower comprehension. Key predictors included income, self-reported health, and insurance type (p < 0.001), while education was weaker than expected. Conclusions: Findings highlight systemic and cultural barriers to HIL in Israel and the need for targeted educational interventions, simplified communication tools, and culturally tailored programs. This study offers a framework for evaluating HIL in publicly funded systems and insights for other multicultural settings.