Economic Considerations of Health Literacy

Roberta Pawlak


Nurs Econ. 2005;23(4):173-180. 

In This Article

Strategies and Incentives

Several strategies and incentives could be considered for population improvement based on this model. A focus on improving the population's literacy levels through public education policy is admirable. Many may argue that to address the complete problem, this would be the preferred method. However, a major change in public education policy would be cumbersome, and Results would take years to realize. In addition, the current adult population would be missed, as the population majority is no longer in public education systems.

A social marketing strategy could be considered as well. Social marketing is the planning and implementation of programs designed to bring about social change using commercial marketing (Social Marketing Institute, 2004). In this strategy, message delivery is targeted specifically to segmented (sometimes geographic) markets. Unless developed for smaller groups with common motivations, the health literacy problem is too broad for a social marketing strategy. Incentives for such a diverse poorly literate population could not be efficiently applied.

One area prioritized as an intervention to improve health literacy by this author is an educational one, with economic incentives. The goal (outcome) recommended to improve population health as it is affected by health literacy is to improve informed consumers. To this end, population health strategy is not on the end-user (the patient). Rather, the focus shift would be applied on the provider, as well as private and public insurance payers. In a mixed-market system such as the United States, providers and payers are major stakeholders in the success of improved health (both financially and professionally). This outcome would address the low-literate, those who do not speak or read English, and those with environmental, social, and cultural environments that affect comprehension or access to current systems of information sharing, particularly the heavy reliance on technology and the written English word.

Strategies recommended for achieving this goal include developing non-reading solutions, imposing regulatory or economic incentives on providers and payers to create such solutions, and expanding research funding in the area of health literacy, health provider, and payer communication with clients. A description of strategy follows.

Just as prospective payment systems, capitation, and managed care have provided economic incentives for system efficiency in health care delivery in the United States, so can incentives for developing non-reading solutions to communicate to consumers about their health care, treatment plans, and payment Methods. To become accredited and paid for services provided, this author recommends providers show how consumers understand their health environment and treatment plans. This outcome measurement can be reported and benchmarked annually, such as QALYs (quality adjusted life years) are for HMOs (health maintenance organizations). Quality improvement plans for improving health literacy should include indicators that show consumers are able to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Lobbying for change in Medicare, Medicaid, and private insurance plans to reimburse primary care settings for education provided by nurses would strengthen the access of low literate individuals and families to information. It may also result in additional avenues for consumers to clarify health treatments, assist in system navigation, and integrate wellness practice into their own health goals.

Health care personnel have spent much time and effort in writing education materials for patients. Much of this material is written above a sixth grade reading level. In the case of insurance companies and the material disseminated by them, often the material is written above the 12th grade reading level. Alternatives to text-laden material for patients can include videos, pictographs, audiotapes, algorhythms, dialogue, computer simulators, etc. A cautionary note for technology application: as discussed previously, to be successful individuals must have access and competence in its use. This ability cannot be assumed, and must be accomplished without adding the burden of additional cost to the consumer. In health system and program planning, system modifiers must consider determinants of health literacy listed on the left hand side of the model in Figure 2. For example, primary language spoken and the existence of learning disabilities must be considered in designing communication and navigation tools for patient education materials.

In addition, policy and funding support for multidisciplinary research on health literacy is needed as a priority from government and private organizations. Through this avenue, efficient mechanisms for improving health literacy can be tested and shared.


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