Report finds low health literacy costs the U.S. billions annually
Recommendations to improve bottom line can be implemented at institutions
The National Patient Safety Foundation based in Adams, MA, posted a report released by the University of Connecticut on its web site (www.npsf.org) in October about the economic impact of low health literacy. The report, "Low Health Literacy: Implications for National Health Policy," stated the cost of low health literacy to the United States economy is in the range of $106-$236 billion.
The report used the Institute of Medicine's definition of health literacy "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions" to discuss the issue.
According to John A. Vernon, PhD, professor in the department of finance at the University of Connecticut in Storrs business school and lead author of the report, the cost is a result of the enormous economic inefficiencies in the health care system due to the fact that many people do not know how to navigate it. For example, people who do not have access to medical care on a regular basis do not know how to navigate the system.
The saying that practice makes perfect applies in this area, says Sara Rosenbaum, JD, chair of the department of health policy at George Washington University School of Public Health and Health Services in Washington, DC, and a co-author of the report.
"You learn how to ride a bike because you have access to a bike and places to ride so you learn to be a good bike rider. The same is true with health care. If you have access to it when you need it and a regular source of care, then you will become a better user of the care," says Rosenbaum.
In addition, those with basic or below basic health literacy don't know how to follow instructions from their physicians and have difficulty filling out insurance forms, Vernon states. "If you don't follow the instructions appropriately or wait until it is too late to see a doctor, you may end up in [the ED] as opposed to preventive care. There is vast literature showing the inefficiencies are very costly," he adds.
Some of the cost is due to avoidable illness and some to the setting in which illness is finally managed, states Rosenbaum.
"People who wait until they are very ill with diabetes and go to an emergency department are potentially much more expensive than those who go to a doctor and manage their diabetes with diet, exercise, and drugs," says Rosenbaum.
The report was prompted by the 2003 U.S. Department of Education National Assessment of Adult Literacy, which determined that 36% of the adult population has basic or below basic health literacy skills.
How might this impact a person's ability to appropriately use health care to achieve good health outcomes? According to the assessment, those with below basic health literacy would not be able to recognize a medical appointment on an appointment form nor would they be able to determine how often a particular medical test is recommended from a clearly written pamphlet.
As people's health literacy decreases so does their ability to undertake increasingly complex tasks within the health care system, states the University of Connecticut report.
Translating cost savings to individual systems
The report concludes that two types of policy interventions are needed. The first is to eliminate disparities in health insurance coverage so people can use health services in a timely and appropriate manner. This intervention would be at a government level. Better coverage alone, though, is not sufficient; research suggests that 75% of those with low health literacy have some sort of insurance, according to the report.
The second intervention is at the point of delivery, where health care providers interact with patients. Health care institutions need to implement staff training programs in the area of low health literacy and patient education must be designed in a way that addresses the needs of those people with basic or below basic health literacy. There must be policies in place to ensure patients understand instructions and are able to navigate through the health care system, according to the recommendations of the report.
The authors stated: "The health care system itself can pose a serious barrier to appropriate care. Fear, embarrassment, and a non-user-friendly health care system are likely to inhibit many people from seeking clarification regarding what is meant by treatment instructions or medical advice. Cultural and language barriers, as well as low general literacy levels, can further exacerbate the problem of effective communication between patients and the health care system."
While the staggering costs in the report were calculated nationwide, low health literacy does impact a health care institution's bottom line. One research study cited in the report found that inpatient spending increased by about $993 for patients with limited health literacy.
Will institutions that address low health literacy see cost savings? According to Vernon it is likely. There would be savings through more appropriate use of health care such as reduced emergency room visits.
SOURCES
For more information on the report, "Low Health Literacy: Implications for National Health Policy:"
- Sara Rosenbaum, JD, Harold and Jane Hirsch Professor of Health Law and Policy, chair, department of health policy, George Washington University School of Public Health and Health Services, Washington, DC. Phone: (202) 530-2343. E-mail: [email protected].
- John A. Vernon, PhD, professor, department of finance in the school of business, University of Connecticut, Storrs. E-mail: [email protected].
Note: For more details on the study mentioned in this article concerning costs see Howard DH, Gazmararian J, Parker R. 2005. The impact of low health literacy on the medical costs of Medicare managed care enrollees. Am J Med 118: 371-377.
The National Patient Safety Foundation based in Adams, MA, posted a report released by the University of Connecticut on its web site (www.npsf.org) in October about the economic impact of low health literacy. The report, "Low Health Literacy: Implications for National Health Policy," stated the cost of low health literacy to the United States economy is in the range of $106-$236 billion.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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