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Health Care Consumers are Confused About Today's Complicated System

Confused PatientWe talk a lot in this country about improving access to health care, but we may be missing a key point: many consumers don’t understand what we’re talking about. They know they need health coverage and may even be able and willing to purchase it, but lack the ability to fully understand what good coverage entails.

Health care is a complex subject even for the reasonably well-educated.

Sometimes health care providers themselves have to seek explanation of coverage, treatment options and procedures. This is particularly true in case management and utilization review.

Often, communication among health care consumers, case managers and insurance companies, third-party administrators or even hospital billing departments are fraught with medico-legal jargon, vague statements, or outright doubletalk. Consumers and providers alike are commonly left muddling through a swampy accounting system that makes American health care unbelievably inefficient.

Providers become leery of offering some services, or begin to charge more for them, because insurance companies play games with payout schedules or seek loopholes to avoid reimbursing them. And many consumers are left with suboptimal health care and unexpected financial burdens

The result is that many consumers give up rather than fight a broken system, praying for the best. But inevitably they get sick or injured, and a significant percentage end up in the emergency room as self-pay patients and often stick the hospitals and doctors with the bill.

That unreimbursed care causes providers to charge more, and the cycle of brinksmanship repeats.

Illiteracy is a problem in America. Health illiteracy is an even bigger problem.

According to the most recent National Assessment of Adult Literacy, only 13% of Americans 16 years and older read at a “Proficient” quantitative level (cumulative score for ability to comprehend written documents and prose alike).

Although the percentage of Americans with reading abilities below basic literacy levels fell slightly from 26% in 1992 to 22% in 2003, the percentage of proficient readers didn’t grow accordingly. The gains were all in basic and intermediate literacy categories.

According to some estimates, up to 77 million Americans — 36% —are “health illiterate,” unable to fully comprehend health-related reading materials they encounter.

Some of this may stem from a lack of understanding about medicine. Some of it may be due to general illiteracy. But much more may be attributable to the way providers and insurance companies convey information. It may have much to do with the amount medico-legal gobbledygook used in these publications.

This has obvious implications when explaining coverage, treatment and prevention options in health care.

The consequences of health illiteracy on wellbeing — and cumulative healthcare waste expenditures — are serious.

According to a study by George Washington University’s School of Public Health & Health Services, low health literacy results in $106 to 238 billion wasted on unnecessary or avoidable health care expenditures every year. Moreover, the study asserts, future costs associated with health illiteracy are expected to balloon into the trillions of dollars if no effective actions are taken to reverse the trend.

But reversal won’t be easy.

Although the federal government has attempted to bring reform through legislation, the real solution may lie in a grassroots movement to increase a sense of value for basic education, literacy, and critical thinking skills among the general populace and to hold parents, students and educators accountable for making gains.

And that’s not going to come from the health care sector.

So what can we do in health care?

First and foremost, we must make sure that we are providing health care consumers with choices and instructions they can understand — which can be difficult when the medico-legal language that patients find confusing is a hedge to screen providers from an overly litigious climate.

But we can, as providers, review our documents, medical literature and sales literature and bring the non-legal language in line with Americans’ overall literacy levels. While this seems like a call to “dumb down,” it is a pragmatic, hopefully temporary, workaround that addresses real market problems.

We can also employ and train more experts to assist consumers with making better choices: financial counselors to explain billing practices and help patients to apply for assistance programs, insurance counselors to walk patients through the purchase and implementation of coverage, and nurse-social worker hybrids to explain diagnoses and treatment options, impart the importance of treatment compliance or even actively manage patients’ treatment compliance.

The initial investment in time and money to review, revise and reprint simpler documents, or to train and staff care management teams, may seem cost-prohibitive to many health care organizations, but measured against trillions of dollars in potential future waste, they could ultimately be a bargain.

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