Three Strategies to Overcome Health Literacy Gaps

Renuka Tipirneni, MD, MSc, FACP

People who don’t understand how their health insurance works are more likely to avoid care. Low health insurance literacy can lead to people skipping basic care, like cancer screenings, according to a new study.

The study, published in JAMA Network, looked at the association between U.S. adults' health insurance literacy and avoidance of healthcare services due to perceived cost.

It found that almost 30% of people surveyed reported delayed or foregone care because of perceived cost, and that those with lower health insurance literacy reported significantly greater avoidance of both preventive and non-preventive healthcare services. Lower health insurance literacy was also associated with less actual use of preventive services.

“These findings suggest that health insurance literacy is important for patients, not only while selecting a health plan, but also in health care navigation and uptake of recommended health services,” according to lead study author Renuka Tipirneni, MD, MSc, FACP, assistant professor, University of Michigan Department of Internal Medicine, Divisions of General Medicine and Hospital Medicine, and Institute for Healthcare Policy & Innovation.

“Navigating health insurance and healthcare choices is challenging and requires significant health insurance literacy-knowledge and application of health insurance concepts,” Tipirneni says.

Patients need help not just selecting health insurance plans, but also understanding their coverage at the point of healthcare delivery, according to Tipirneni.

Related article: Three Surprising Things Health Execs Should Know About Health Literacy

“Clinicians, health plans, and policy makers should adopt communication strategies that make health insurance concepts accessible to patients, regardless of their health insurance literacy, and improve patients' understanding of services exempt from out-of-pocket costs,” he says.

How low literacy hurts healthcare

“This is important to healthcare executives because we’re seeing people come into hospitals with complications and exacerbated conditions that might have been avoided had they initially sought proper primary care services,” says Dave Chase, author of “The CEO’s Guide to Restoring the American Dream” and co-founder ofHealth Rosetta, which promotes reform for the U.S. healthcare system. “Many doctors are already overworked as it is-and prone to burnout. Spending time to treat issues that could have been altogether avoided means more time on the floor, and less time to go around for the rest of the patients.”

It’s common knowledge that healthcare costs are continually rising, but the reason prices are going up is not because the cost for actual health services are-with some limited exceptions such as specialty drugs, according to Chase.

“Healthcare execs can see in their own practices that these cash prices change little over the years,” he says. “What’s really driving these increases is the insurance bureaucracy that exists within the employer/benefit advisor relationship. The effects of this bureaucracy trickle down to employees in the form of increasing costs and a subsequent avoidance of care in order to save their wallets.”

Understanding health insurance coverage is important when patients decide whether or not they will engage in preventive services, according to Chase. “Because of low health literacy, too many people don’t understand what coverage they have, what they are entitled to, or how to access the best options out there.”

Even if they decide to see a doctor, there’s a misconception that high cost equals high quality, according to Chase. “In reality, it is possible to access high-value care at a fraction of the cost. Healthcare execs should ensure they are part of this demographic, focusing on patient outcomes and value-based solutions,” he says.

“Because preventive care doesn’t address acute needs or distressing symptoms, people may see it as less valuable,” Chase says. “In reality, our broken primary care system has played a large role in the destruction of our current healthcare system. If we could start providing quality care at the beginning, where doctors can address the root causes of a patient’s pain or discomfort, we could start showing how valuable it is to prevent conditions before they occur or manage them early in a disease progression.”

Avoiding care due to a lack of literacy is a problem and there are three healthcare executives can address it:

• Employers should provide a better understanding of health benefit options, which will lead to improved access to vital care and services.

• Work to communicate in plain language about valuable primary care options. “Individuals cannot make the best choices for themselves and their health unless we help them learn what those choices are,” says Chase. “For example, most people aren’t aware that the number one driver of disability is lower-back pain and that lower-back pain is the number one reason for opioid prescriptions. Sadly, there is no evidence opioids are the most effective treatment for lower-back pain. Further, there are very few instances where spinal injections or surgeries are the most effective treatment. In the last 10 years, surgeries have increased by 220% and spinal injections 629%.”

• Ensure your staff is working toward high-value outcomes for all patients and conditions.