Low Health Literacy, High Health Costs

When Joe Smith walks into a bar, chances are he isn't going to order an “alcoholic libation” to quench his thirst. He's going to order a beer.

The same scenario—minus the beer—applies when Joe Smith walks into a hospital or clinic for treatment. He isn't going to ask the doc to check for “hyperlipidemia” —more likely he’ll ask about high cholesterol.

Mr. Smith represents an average patient with average health literacy—the ability to read, understand, and act on health information. Patients with low health literacy may have trouble understanding medication instructions or comprehending the details of a consent form.

Health literacy is one of the least recognized, but one of the most widespread challenges to achieving better health outcomes and lowering healthcare costs in the U.S., according to the National Patient Safety Foundation (NPSF).

This problem, when quantified, is astounding. Low health literacy costs the U.S. more than $58 billion annually and nearly half the U.S. adult population (90 million people) fall into the low or basic health literacy category. Countless common medical errors can be prevented if the gap in health literacy is addressed.

According to NPSF, typically the low health literate patient has:

• A poorer health status
• Less treatment adherence
• A greater number of medication/treatment errors
• Higher rates of health services utilization, including 29%–69% higher hospitalization rates
• Higher health care costs:
  • $50–$73 billion in additional health expenditures annually
  • $7,500 more in annual healthcare costs for a person with limited health literacy, versus a person with higher health literacy skills

“What factor is the strongest indicator of an individual’s health status? Is it age, income level, race, or literacy? Would it surprise you to know that it is literacy skills?” says Barbara A. DeBuono, MD, MPH, chair of the Board for Partnership for Clear Health Communication at NPSF. “While some groups, particularly the elderly and poor, are at risk, all populations are at risk.”

Confusing signage or medical jargon can leave a patient lost, both physically within a healthcare facility and in terms of the direction of their care. Here's where marketers need to step in to create a clearer path of communication to reach these patients.

“You come out of that examination room with the intelligent man or woman thinking, ‘God, I hope I don’t make a mistake with my medicine’,” says a lupus patient with a fifth-grade reading level in an interview with the American College of Physicians. “I did not understand anything he or she was saying.”

The challenge is finding a way to reach these audiences to encourage them to engage in their healthcare. Experts recommend assuming that everyone may have difficulty understanding and creating an environment where all patients can thrive.

Removing literacy-related barriers will improve care for all patients, regardless of their level of health literacy.

The Agency for Healthcare Research and Quality provides a thorough health literacy toolkit on its website. I've summarized some of the key takeaways in these four steps:

1. Educate. If you're reading this article right now, you are already educating yourself on the topic of health literacy. Check out this video from the ACP Foundation for further information and share with staff to obtain leadership buy-in.

After educating staff, it is time to educate the patient. Physicians can be reminded to encourage the patient to ask questions and use the “teach back” method of asking the patient to repeat what they have learned from their visit. Education can also come from posters and signage encouraging patients to speak up or ask how to take their medicine.

2. Collaborate. Put together a team in charge of evaluating and setting standards to improve health literacy across the organization. It's important that members of the group come from different departments.

3. Assess. Encourage physicians and staff to take a 30 minute self-assessment to see where they rank on communication and discuss the answers in a follow up session. Know where your organization’s strengths and weaknesses are in terms of communication.

4. Build goals. Now that you’ve assessed your organization’s health literacy weaknesses, set up ways to measure improved outcomes. Example: Set up systems to remind patients to attend cancer screenings over the next six months and record if an increased number of patients attend the free screening.

And last but not least, here is the marketer's bible: The Plain Language Thesaurus for Health Communications. It's the layman's healthcare dictionary that cuts through heavy healthcare jargon. When creating marketing copy, use this as a translation tool.

Language is a tricky beast to conquer, especially when patients have many different education levels and backgrounds. Some patients are visual learners while others understand better by listening.

A case study from the Journal of the American Medical Association (JAMA) shows that literacy can help determine which patients would benefit from an intervention for disease management. In areas where many patients have low literacy, access to disease management programs could help reduce health disparities, the study concludes.

My recommendation is that more hospitals and practices should assess and measure their health literacy rates to make measurable progress with improved standards.