Employees Who Understand Health Care Use it More Efficiently

Nearly half of American adults have difficulty understanding and using health care information, according to a report from the Institute of Medicine of the National Academies. The fact that 90 million adults cannot effectively comprehend the medical information they receive comes at a time when individuals are increasingly expected to be smarter, better health care consumers.

Health Literacy and Illiteracy

Broadly defined, health literacy involves the ability to read, understand, and act on health care information. According to the Institute of Medicine, health literacy measures more than a person's reading skills. It also includes writing, listening, speaking, conceptual knowledge and the ability to do arithmetic.

The need for this type of literacy is apparent at every juncture in the health care system. Patients need to be able to read medical appointment reminders, understand instructions on a prescription bottle, comprehend test results and follow instructions from a physician. People with health insurance must be able to understand their coverage and interact with customer service representatives.

A lack of knowledge hampers the ability to understand what can be done to improve one's health and make informed decisions about treatments and therapies.

Health illiteracy has its costs. People with lower functional literacy use more health care services and have a poorer ability to appropriately care for chronic medical conditions, according to the Center for Health Care Strategies (CHCS). For example, adults with functional literacy in the bottom 20 percent are likely to have three times as many prescriptions filled as adults with higher literacy. Emergency room patients with inadequate literacy are twice as likely to be hospitalized. And among adults admitted for an overnight hospital stay, those with low health literacy averaged six percent more hospital visits and stayed in the hospital nearly two days longer than adults with higher health literacy. Such extended use of the health care system obviously translates into higher medical costs.

Bottom line: When people have trouble understanding medical information -- including health plan and health care communications -- they are less likely to make the most effective use of the system from a cost and treatment perspective. For example, a summary plan description may describe in exact detail the coverage provided by a health plan, but if it is written at too high a reading level, employees may not bother to read it. Then, when faced with a medical situation, the employee heads for the nearest emergency room, where the treatment cost for a condition better handled through an office visit (such as an ear infection) is much higher. Similarly, instructions and explanations given by physicians, if too complex and peppered with medical jargon, can result in unnecessary return visits for clarifications.

It Doesn't Have to Be This Way

Clearly, all players in the health care system -- patients, providers, insurers, employers and plan sponsors -- can work to improve health care literacy. Employers should focus on the readability of benefit booklets, summary plan descriptions, and enrollment forms. Examine these communication materials for simple words and phrasing, easy-to-locate information, and clarity of instructions. In addition, it's helpful to have a go-to person who can answer questions and explain the details of available health care benefits. Most insurers also provide toll-free phone numbers where plan members can ask specific questions about coverage. This adds a measure of privacy for employees who may not want to reveal medical needs to their employer's on-staff benefits adviser.

These measures are only the beginning of health care education, but they are important first steps that can enhance the health literacy of employees. Increased understanding has the potential to reduce medical costs, both for individual companies and the general public.

Who Has Trouble?

Older people, non-whites, immigrants, and those with low incomes are disproportionately more likely to have trouble reading and understanding health-related information, according to the CHCS.

However, a complex health care system makes people from all income and education levels susceptible to not understanding.

"Compounding the problem is the fact that most patients hide their confusion from their doctors because they are too ashamed and intimidated to ask for help," according to the American Medical Association Foundation.