Low Health Literacy Leads to Increased Healthcare Costs
Sitting in a physician's office wearing nothing but a paper thin gown can be daunting in and of itself. Now imagine, your white coat syndrome worsens as your doctor throws out unfamiliar vocabulary, as your mind draws a blank. If this sounds familiar, you're not alone, according to Archives of Internal Medicine most patients only understand and retain about half of what a provider tells them, and do not feel comfortable asking providers to clarify.
Approximately 90 million people in the United States lack the basic skills or proficiency necessary to understand and use health information as reported by The Institute of Medicine. National data from the Center for Education Statistics suggests that only 12 percent of American adults have proficient health literacy skills - reading, writing, understanding, computing, communication and using health information.
The growing disparity in health literacy is directly impacting patient health. Low health literacy has been estimated to cost the U.S. economy between $106 billion and $236 billion annually reported by the Center for Health Policy Research. As defined in Health People 2010, Health literacy is:"The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions."
The problem affects patients of all demographics. People of all ages, race, income and education levels have a difficult time communicating with healthcare providers. Health literacy can also be influenced by culture, language, religion and belief systems.
For instance, in the southern United States, the word "sugar" is commonly used as a synonym for diabetes. For those suffering from the "sugar", treatment information that refers to their illness as diabetes may be completely missed by patients.
The Impact of the Patient Protection and Affordable Care Act (ACA)
The ACA is a major component of Healthcare Reform, impacting tens of millions of Americans at a cost of nearly one trillion dollars over the next 10 years. Its primary goal is to provide additional coverage at affordable rates and help control healthcare costs.
With the inception of the ACA, an additional 32 million lower-income adults will be provided with health insurance coverage reported by The Institute of Medicine. Most of those adults have probably never visited a physician's office for routine screening and have used the emergency room as their primary source for care.
More people, means more opportunity for patients to misinterpret recommendations or medical protocols and not fully understand the bearing that preventative care has on healthcare costs.
Taking Action, being Accountable
Low health literacy can be a crucial determinant in how well a patient manages a chronic condition such as high blood pressure, diabetes, or emphysema by severely limiting access to appropriate services. Low health literacy is also associated with reduced use of preventative services, delays in diagnoses, poor adherence to medical instructions, poor understanding and management of chronic conditions, and higher mortality, states the Agency for Healthcare Research and Quality.
One study following a group of 2,956 participants published in Social Science & Medicine found that 43.4 percent of those who died within a five and half year follow-up, were participants who had the lowest literacy scores. In comparison, only 14 percent of those who died were from the highest literacy score group.
Being able to understand and negotiate one's healthcare choices is crucial. By passing on health accountability solely to the practitioner, we are more likely to miss opportunities for better care and catching symptoms early on-increasing healthcare costs in the long run.
The Prescription to Improve Health Literacy
It starts with the recognition that all parties that contribute to the problem (patients, providers and government) must be part of the solution. Too often patients hide confusion and feel intimidated, nodding approvingly as their physician tries to explain diagnosis and prognosis information. Patients must:
- become more aware of resources available
- sharpen their listening skills when advocating for themselves in the doctor's office
- be proactive and not deferential to physicians
As the budgets for Medicare and Medicaid continue to grow, it will become increasingly more important for state and federal governments to educate beneficiaries to eliminate wasteful and unnecessary spending. Government entities on all levels will need to:
- create uniform and culturally appropriate new measures of health literacy
- fund additional research on the extent and consequences of limited health literacy
The physician community can have a tremendous impact on the problem starting with how effectively and efficiently they communicate with their patients. Physicians must:
- be direct with patients, but make them feel comfortable to ask questions & clarify terms
- use "plain language skills" in brochures, letters, self-care instructions etc. that is easier to comprehend
- use pictures and illustrations, transform dense paragraphs into bullet points on consent forms, and use larger font size
For example, a physician might say this "Your most recent hemoglobin A1C is 9.5- we need to aim for tighter glucose control to prevent future complications." but could say this "Your hemoglobin A1C, which shows me a 3 month average of your blood sugar levels is 9.5, This translates to your estimated average blood sugars being 226.
We need to stay in the ranges we discussed earlier to prevent complications such as eye, kidney, and cardiovascular disease". It's not about omitting information or "dumbing it down". It's about using simple language, formats and styles that lead to clear and effective communication.
Finally, as more and more Americans enter the healthcare system and care is provided no matter what socio-economic class one belongs to, it is imperative that patients understand why and how they are being treated, physicians understand what "effectively communicating" really means, and government agencies understand that they need to set policies to address the importance of eliminating low health literacy.
About the Author:
Paul Rooney, CEBS Managing Partner, EBS Capstone As Managing Partner of EBS Capstone, Mr. Rooney specializes in advising employers on group health, life and disability benefit funding methods, plan design, cost containment, flexible benefits, and state and federal compliance issues.
Over the past 25 years, Mr. Rooney has had extensive experience in the area of managed care, specifically developing plans for multi-state employers and negotiating pricing with various managed care companies.
