Health literacy: A medical conundrum and a health insurance hurdle

Roughly nine out of ten people have low health literacy, which means they have trouble understanding basic health information and making appropriate decisions. It’s a costly issue in terms of personal wellbeing and overall healthcare costs.

The Centers for Disease Control (CDC) reports that more than 90 million adults in the United States have low health literacy, which means they may not access care when they should, they aren’t taking advantage of preventive services, they may not follow doctors’ orders, and they’re more likely to end up in the emergency department.

This health literacy epidemic costs the U.S. economy an estimated $106 billion to $238 billion annually, according to a 2006 Department of Education Study (PDF). That’s between 7 percent and 17 percent of all personal health care expenditures.

Reading ability, vocabulary limits and math skills all contribute to the issue. For example, some people with chronic conditions have trouble calculating their cholesterol and blood sugar levels, measuring medications or understanding nutrition labels. Nearly half of all patients make mistakes with their prescriptions because they misunderstand the dose instructions.

The stress of illness is also a contributing factor, even for those who are well-educated. Research published in the journal Pediatrics linked relapses of children with kidney disease with parents’ ability to understand and follow directions in times of duress.

Keeping it simple

There’s a nationwide move underway to make it easier for everyone to understand and use health information. Plain language guidelines have been adopted at the federal level, and resources like Washington University’s “Plain Language Thesaurus for Health Communications” (PDF) are gaining traction with providers. The thesaurus offers plain language replacements for multi-syllabic technical terms. Recommendations include using “bruise” instead of “contusion;” “stop” instead of “discontinue;” “cut” instead of “incision;” and “blood clot” instead of “embolism.”

Hospitals and physician offices are creating plain-language print and online materials about medical conditions, with helpful illustrations about difficult-to-understand concepts. And they’re inviting patient dialogue by using open-ended questions instead of those with a yes-no response. For instance, many providers now ask, “What questions do you have?” instead of the conversation-ending question, “Do you have any questions?”

Improving health insurance literacy

It’s no secret that health insurance has confused consumers for years. Many people — especially the young and those who are less educated — don’t completely understand basic health insurance terms and concepts, according to a study conducted by The Kaiser Family Foundation. For example:

  • Seven out of ten correctly identified the definition of a deductible or copay, but only half were able to calculate how much they would pay for a four-day hospital stay with a $1000 deductible and a $250-per-day copay.
  • Only 16 percent could calculate the cost of an out-of-network lab test when the insurer pays 60 percent of allowed charges.
  • Only one-third correctly identified the best description of a health insurance formulary.

What does this mean for employers? Many employees need extra support to understand their coverage, especially if they have a high deductible health plan.

Knowledge is power. In addition to outlining health plan details during open enrollment, look for opportunities to provide education throughout the year. Employees who understand the advantages of no-cost preventive care, in-network providers and transparency tools can stay healthier and help employers keep the lid on costs. And those who can properly calculate expenses will be better equipped to make good use of medical spending accounts.

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