Why Westerners Are Dissatisfied: A Cross-Sectional Study Identifying State-Level Factors Associated with Variation in Private Health Insurance Satisfaction

ImportanceLarge regional variations in consumer satisfaction with private health insurance plans have been observed, but the factors driving this variation are unknown. ObjectiveTo identify explanatory state-level and insurance family-level predictors of satsifaction with private health insurance. DesignCross-sectional study examining regional and state variations in consumer health insurance plan satisfaction using National Committee for Quality Assurance data from 2015 to 2018, state-level health data and parent insurance family. SettingUS Population ParticipantsPrivately insured individuals. ExposureOne of 2176 private health insurance plans. Main OutcomeConsumer satisfaction with the health insurance plan on a 0-5 scale. RESULTSConsumer satisfaction with health insurance was consistently lowest in the West (p<0.0001). Lower private health insurance plan satisfaction was associated with the percentage of the population without a place of usual medical care, the percentage of the state population that is Hispanic, and the percentage of the population reporting any mental illness. Factors associated with increasing insurance satisfaction included higher healthcare spending per capita, a higher number of for-profit beds per capita, and an increased cancer death rate. Increased consumer satisfaction was associated with the Kaiser and Anthem insurance plan families. Conclusions and RelevanceState and insurer family factors are predictive of private health insurance plan satisfaction. Potentially modifiable factors include access to primary care, healthcare spending per capita, and numbers of for-profit hospital beds. This information will help consumers hold insurance providers accountable to provide higher quality and more desirable coverage and provide actionable items to improve health insurance satisfaction.