Employers Overlook Hidden Costs Of Health Literacy
By: Gloria Mayer
A recent survey showed that 30 per cent of employees are not getting the full benefit of their plan simply because they don’t understand what is being offered. Gloria Mayer, president of the Institute for Healthcare Advancement, and Paul Okeefe, of the Canadian Worksite Marketing Group, offer ideas on how communicating with employees on a level they can understand can improve your plan.
Often overlooked in the drive to control costs and medical outcomes is a bigger issue, particularly if a company employs a significant number of blue collar workers – low health literacy and the resulting inability of the employee to understand what healthcare providers and health plans are trying to communicate.
Whether it involves preventive health materials, pharmacy directions, or postsurgical instructions, this communication disconnect is becoming very expensive for employers.
According to the National Academy on an Aging Society, employers pay an estimated $12 billion in wasted healthcare dollars annually due to the inability of patients to understand their healthcare providers’ and plan’s information. That is nearly 17 per cent of total dollars employers spent on healthcare coverage each year. Together with other payments for medical services, it is estimated that the U.S. spends $73 billion on this problem annually.
Why is this? The answer is that what is often overlooked in healthcare management and delivery is the reading level of the average plan population.
Low health literacy refers to the set of skills needed to read, understand, and act on basic healthcare information. More than 90 million American adults with low health literacy have difficulty understanding instructions on prescriptions or medicine bottles, appointment slips, insurance forms, and informed consent forms. The result is higher utilization of services.
So, while magnetic resonance imaging, laser procedures, robotic surgeries, and an ever-widening number of treatments ensure better health outcomes, the U.S. is still not a nation of ‘healthy people.’ Among many other reasons, the lack of appropriate communication stands in the way.
In a nationally representative sampling of the U.S. adult population, the National Academy on an Aging society found that:
- Among adults who stayed overnight in a hospital, those with low health literacy skills averaged six per cent more hospital visits and stayed in the hospital an average of two days longer than adults with higher health literacy skills.
- Among adults with at least one doctor visit, those with low health literacy skills had on average more doctor visits than adults with higher health literacy skills.
- When self-reported health status is taken into account, patients with low health literacy had fewer doctor visits but used substantially more hospital resources.1
Until the nation effectively addresses the issue of low literacy, adults with low literacy skills will be twice as likely to:
Report their health as poor
- Be hospitalized
- Misunderstand medical instruction
- Misunderstand return appointment instructions
- Have difficulty navigating to and within a hospital environment
- Have difficulty understanding informed consent2
Why is medical information written at the sixth grade or lower reading level so important? If an HMO member knows to sponge, give fluids, and cool a room to reduce her baby’s fever, she has less chance of taking her sick child to the emergency room. If a plan member follows six quick steps to clear the air passage of their choking baby, she and her baby can be spared from having to call 911. If a page of pictures and information can quickly convey to a home caregiver that one of her charges has Pink Eye, she can act quickly to prevent its spread to siblings, cutting down on visits to the doctor.
While statistics tell us that eight out of 10 ER visits could have been avoided, health plans and employers continue to struggle to create understandable information that can empower plan members to handle medical problems. To this end, employers, who are important players in the payment process, should be engaged in finding strategies to tackle this low heath literacy problem.
Unfortunately, health literacy is an area in which research has far outpaced any corrective actions taken in the field. However, there are a number of immediate and practical actions that employers can take in order to make a difference. Here are some initial steps to consider:
1. Review Company Healthcare Materials
Most health promotion materials are written at the 10th grade reading level. Meanwhile, the average adult reads at the sixth grade level. Therefore, as part of any ongoing HR effort, employee health and wellness materials need to be purchased with this reading level in mind, or created within the company, making sure the level of written communication is appropriate.
2. Conduct Focus Groups
The best way to get to the heart of this issue is to consider conducting a series of focus groups with employees. This can be done by holding small sessions of six to eight people whereby the company’s current health plan materials are passed out and ‘tested.’ Once the material is read, participants can either give verbal or written feedback as to the areas they did and didn’t understand. Video materials can be reviewed in this same manner. It’s important to keep in mind that while the audiovisual medium solves reading problems, the use of many sophisticated medical terms also serves to create miscommunication.
If your company has the resources, a professional focus group consultant can conduct sessions with employees. These experts can screen the written and video materials that your health plans currently use in a discrete process that includes handing out and using hand-held rotating dial machines that allow each participant to turn ‘up’ and ‘down’ the understandability level (like a volume indicator) to identify which portions of the material they understood and those they didn’t. The outcome of this mechanized process can be documented for use in future benefit planning meetings.
3. Review Health Plans’ Low Literacy Efforts
When negotiating healthcare benefits, take time to review employee literature that comes from the insurance company or the network of providers and hospitals. Is it easy to understand? Is the health information you give employees easy to navigate? If the information is long, burdensome, uses small print, or is written in medical jargon and complicated language, you can be sure that some of your employees will not understand it. As an employer, you can request literature at a lower reading level. You should also query plan representatives as to the extent of their company’s efforts to get medical providers to reduce the use of complicated medical jargon.
4. Provide Employees with Easy-to- Read Healthcare Reference Books
Another strategy is to provide your employees with easy-to-read and easy-touse general healthcare materials and reference books. Significantly, these books teach people how to stay healthy, treat selflimiting conditions, and decide when it is appropriate to self-treat at home or visit an emergency room, urgent care centre, or the doctor’s office. Studies have found that self-help health books were effective in reducing both office and emergency room visits. Additionally, the books increased individuals’ confidence in handling healthcare situations and enabled them to selftreat minor medical conditions using the information provided in their books. These studies found that up to 90 per cent of the individuals consulted the books at some time during a six month period, leading to a feeling of self-empowerment and fewer trips to the primary care doctor or clinic. Another study found that simply giving U.S. employees self-help medical care guides can generate savings of up to 11 per cent of ER costs.
The point is that we seem to have a reliable stream of evidence to support the notion that people with low health literacy skills will indeed modify their behaviour if they are given materials that they can understand and use. What To Do When Your Child Gets Sick is an example of a book that would be appropriate for this type of employee empowerment program. It is written at a third to fifth grade reading level. The book incorporates the principles of low-literacy writing and formatting. For instance, the book uses large, 14-point type, numerous simple illustrations, and a standardized format for discussing each topic.
5. Make Use of Public Resources to Help Remediate the Problem
The good news is that there are literacy programs to help your employees at most public libraries. They are free to the public. If an employee cannot read and communicates that fact, a referral to the public library’s reading program may be appropriate. Of course, many employees never mention that they cannot read. For these people, preparing information at a third to fifth grade level is critical.
Given the hard-to-ignore cost of healthcare over-utilization that is clearly linked to low health literacy, it’s important that employers, as well as municipal agencies, re-examine how to better equip low level readers with tools they can use to improve their health and access to healthcare services.
Gloria Mayer is president of the Institute for Healthcare Advancement.
1. National Academy on an Aging Society. Understanding Health Literacy: News Estimates of the Costs of Inadequate Health Literacy. Presented October 7-8, 1998: Washington D.C.
2. California Health Literacy, Inc. Health Literacy Action Agenda. May 2002.
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