How Health Insurance Knowledge Relates to Healthcare Utilization: Insights from Switzerland

Abstract Background In Switzerland, basic health insurance is compulsory for all residents. A foundational level of health insurance knowledge (HIK) may be relevant to how individuals navigate a complex, choice-based insurance system and use healthcare. Methods Using data from the 2015 Swiss Health Behavior Survey (n = 1874), this study examined the association between selected dimensions of HIK and the number of doctor visits in the past 12 months. Probit and hurdle negative binomial (HNB) regression models were applied to investigate sociodemographic variations in HIK and its association with physician visits. Results Probit models showed that HIK varied across sociodemographic groups, most consistently by age. In unadjusted HNB models, greater HIK, particularly knowledge of the open enrollment policy, was associated with fewer doctor visits among those with at least one visit. This association diminished substantially after controlling for sociodemographic and health-related characteristics and was no longer statistically significant in the full sample. Physician visits were also associated with health status, age, gender, and household size. However, a robustness check restricted to respondents unexposed to a preceding question explicitly stating the open enrollment policy showed that the association between open enrollment knowledge and physician visits remained statistically significant. Conclusions HIK exhibited demographic patterning but no consistent association with the number of doctor visits after adjustment. Differences in estimates between the full and unexposed samples indicate that the observed HIK–utilization association may be sensitive to survey context. The demographic variations in HIK highlight the importance of accessible and understandable health insurance information, though such efforts should not be assumed to change utilization. Moreover, the potential relevance of HIK to healthcare utilization beyond the frequency of physician visits warrants further investigation.