Expert Voices

Low Health Literacy Compromises Health, Increases Costs

A patient’s health literacy — ability to understand medical language, actively listen, analyze treatment plans, make daily decisions and ask health providers relevant questions — can impact health outcomes and medical adherence, say health experts.

Health literacy is what helps the patient understand directions on prescription bottles, consent forms, brochures, appointment information and how to navigate our country’s complex healthcare system. The quality of communication between the patient, provider and pharmacist is key.

Often, years of education and general reading ability have little to do with how someone comprehends medical information. Sometimes even highly educated, literate people have difficulty understanding graphs and visual data, interpreting test results, analyzing risks and benefits, quickly navigating technology and calculating dosages.

According to the American Medical Association, low health literacy has been associated with poorer health, higher medical expenses, medication non-adherence and increased hospitalization. In the report, “Health Literacy, A Prescription to End Confusion,” the Institute of Medicine states, "efforts to improve quality, reduce costs, and reduce disparities cannot succeed without simultaneous improvements in health literacy."

Though each patient’s skills are a critical factor, they are only part of the equation. Communication and understanding is balanced by providers and pharmacists. Health care providers are sometimes challenged with learning how to properly disseminate information to different audiences, and to intuit when a patient doesn’t understand.

According to the National Library of Medicine, poor health literacy begets poor health outcomes: People who struggle with health literacy are less likely to get flu shots and understand medical instructions. They are more likely to make medication errors. In general, they are also less likely to seek and receive preventative care and more likely to become hospitalized and have negative disease outcomes.  

Research also indicates that older adults are uniquely affected. People 65 and older make nearly twice as many physician visits per year compared to adults 45 to 65, but two-thirds of older people are unable to understand the information given to them about their prescription medications, according to the National Institutes of Health.

In fact, although older adults are more prone to chronic illnesses and require more medical services than other age groups, 71 percent have difficulty using printed materials, 80 percent have difficulty understanding charts, and 68 percent have difficulty interpreting numbers and performing calculations.

Poor health literacy can result in poor health outcomes and increased medical costs for patients and the health care system. For example, people who have type 2 diabetes and low levels of health literacy typically have worse glycemic control and higher rates of retinopathy. Those with asthma are more likely to go to the emergency room for an asthma attack, a financial burden for both patients and providers.

The National Institutes for Health (NIH) identifies the lack of health literacy as a “major source of economic inefficiency in the US healthcare system,” and attributes $106 billion to $238 billion each year to its side effects.

Though each patient’s skills are a critical factor, they are only part of the equation. Communication and understanding can be helped by providers and pharmacists. Health care providers are sometimes challenged with learning how to best share information with different audiences, and to recognize when a patient doesn’t understand. Many organizations, like the American Medical Association, the American Dental Association, the American College of Physicians, the American Academy of Pediatrics, many insurance companies and some pharmaceutical manufacturers have acknowledged the need for greater health literacy.

Among them, MinuteClinic, the medical clinic in CVS/pharmacy, was the nation’s first retail clinic provider to implement the “Ask Me 3” health literacy program designed by the National Patient Safety Foundation. The program aims to enhance communications between patients and pharmacists by encouraging patients to ask and understand the answers to three questions: What is my main problem? What do I need to do? Why is it important for me to do this?