Economic Considerations of Health Literacy
- 8/20/2005
Two areas it affects are health and health care. Health literacy is increasingly important to help people navigate complex health systems and better manage their own health. The consequences of inadequate health literacy include poorer health status, lack of medical care knowledge, impaired comprehension of medical information, lack of knowledge about medical conditions, lack of understanding and use of preventive services, poorer self-reported health, poorer compliance rates with treatment modalities, increased hospitalizations, and increased health care costs (Andrus & Roth, 2002). People with low health literacy are more likely to report poor health, have an incomplete understanding of their health problems and treatment, and are at greater risk of hospitalization (Baker, Parker, Williams, Clark, & Nurss, 1997).
The U.S. government's first study on adult literacy, the National Adult Literacy Survey, found that 48% of adults do not have the literacy skills necessary to function adequately in our society. A set of leading health indicators, which focus on key health improvement activities described in Healthy People 2010: Understanding and Improving Health, all depend to some extent on effective health communication and reducing health disparities in the United States (Department of Health and Human Services [DHHS]). The Institute of Medicine (IOM, 2004) recently published a comprehensive report outlining the current issues related to this topic, and how health outcomes and costs may be influenced by this problem. These reports and initiatives outline the need for practice guidelines to promote better provider-patient communication, as well as additional evidence about the process of health information- seeking behavior and the role of health information in consumer decision making. Differences in the ability to obtain, process, and understand materials related to health services appear to contribute to health disparities.
In addition, organizations such as the American Medical Association (AMA) and the Joint Commission on Accreditation of Health Care Organizations (JCAHO) recognize the importance of identifying and modifying services to reach out to low literate patients (Kefalides, 1999). The AMA Council on Scientific Affairs adopted recommendations in 1998 that recognize illiteracy as a barrier to health care and called for increased funding for research and education of practicing physicians and medical students (Parker, Ratzan, & Lune, 2003). Standards from JCAHO direct hospitals to evaluate systematically the extent to which patients understand informed consent and instructions (Kefalides, 1999).
Nursing's Social Policy Statement [American Nurses Association [ANA], 2003) calls upon the profession to recognize and be involved in the process of care, public policy, and the health care delivery system as these components of care influence the health and well- being of our society. Specifically, the ANA's Code of Ethics (2001) outlines the patient's right to self-determination (as the philosophical basis for informed consent in health care) and states: "Patients have the moral and legal right to determine what will be done with their own person; to be given accurate, complete, and understandable information in a manner that facilitates an informed judgment; to be assisted with weighing the benefits, burdens, and available options in their treatment, including the choice of no treatment; ...and to be given necessary support throughout the decision-making and treatment process" (p. 8).
Health Economic Issues
Economics is defined as the allocation of scarce resources. Health-oriented activities consume a large portion of economic resources of modern societies, such as the United States, in the production and distribution of health care. Health care is not free. It represents a major commitment of resources: time, energy, skill development, raw materials, and capital, which are then unavailable for other forms of production (Evans & Stoddart, 1990). Health spending is predicted to outpace the overall U.S. economy by 2.5% per year, resulting in growth from 13.2% of GDP in 2000 to 17% in 2010 (Kindig & Newsom, 2002). National health care expenditures in the United States are predicted to rise in excess of $3 trillion by 2012 (Heffler et al., 2002). Weiss and colleagues (1994) caution the average annual health care costs of persons with very low literacy may be four times greater than for the general population. Low literacy, an aging population, prevalence of chronic conditions, and a complicated health care system influence and magnify health disparities in the United States. Illiteracy places an additional cost burden on the U.S. health system, with complicated economic implications.
Definitions and Measurement Tools
Health literacy is defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions (DHHS, 2000). This could include obtaining, interpreting, and processing health insurance plans or complying with prescribed treatment plans given by a health provider. Functional health literacy is operationally defined as the ability of patients to perform basic reading tasks required to function in the health care environment (Williams et al., 1995), and could include the ability of reading drug prescription bottles. Literacy is defined as the ability to read, write, and speak in English and to compute and solve problems at levels of proficiency necessary to function on the job and in society, to achieve one's goals, and to develop one's knowledge and potential (Selden et al., 2000). Available literacy and functional health literacy tests can be found in Table I, and focus primarily on the ability of reading numbers and words. Research is needed to improve the measurement of health literacy, as this concept is much broader than the current literacy tools are able to capture...
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Anthony J. Jannetti, Inc.
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