Health Literacy Could Reduce Medicare Expenses

MedPAC, the Congressional advisory committee on Medicare, discussed how to get patients more involved in their health decisions.

U.S. health secretary Kathleen Sebelius gestures during a press conference at the United Nations headquarters in Geneva, Switzerland, Tuesday, May 17, 2011. Sebelius is in Geneva to attend the annual meeting of the World Health Organization, WHO. (AP Photo/Anja Niedringhaus)
Clara Ritger
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Clara Ritger
Sept. 13, 2013, 9:31 a.m.

Pa­tients ““ par­tic­u­larly minor­it­ies and those on Medi­care ““ are not act­ively mak­ing de­cisions about their treat­ments and pro­ced­ures be­cause doc­tor-pa­tient com­mu­nic­a­tion is poor, ac­cord­ing to a study presen­ted Thursday to Med­PAC, the Con­gres­sion­al ad­vis­ory com­mit­tee on Medi­care.

The res­ult is a great­er ex­pense for Medi­care and a lack of em­power­ment among pa­tients.

“Once pa­tients un­der­stand the risks and be­ne­fits of ex­pens­ive pro­ced­ures, they tend to opt for more con­ser­vat­ive treat­ment op­tions,” said Rita Red­berg, a Med­PAC mem­ber and pro­fess­or at the Uni­versity of Cali­for­nia San Fran­cisco School of Medi­cine.

It’s the reas­on phys­i­cians and hos­pit­als are res­ist­ing train­ing pro­grams that would teach care pro­viders to in­clude pa­tients in the de­cision-mak­ing pro­cess, Red­berg said, be­cause they lose money when pa­tients choose less-costly op­tions.

The de­lib­er­a­tions of the 17 Med­PAC mem­bers will be presen­ted as re­com­mend­a­tions to Con­gress and the De­part­ment of Health and Hu­man Ser­vices.

Im­prov­ing health lit­er­acy, or the abil­ity of pa­tients to un­der­stand their health care and make in­formed de­cisions, is a stated pri­or­ity for HHS Sec­ret­ary Kath­leen Se­beli­us.

It’s a pri­or­ity that could come with sig­ni­fic­ant fin­an­cial im­plic­a­tions for the United States. In 2007, a team of re­search­ers es­tim­ated that low health lit­er­acy costs the U.S. between $106 and $236 bil­lion an­nu­ally. A num­ber of factors ac­count for those costs, in­clud­ing a pa­tient’s in­ab­il­ity to find the best pro­vider, treat­ment and ser­vices for his or her con­di­tion. The re­search­ers ar­gue the sav­ings would be enough to in­sure all of the more than 47 mil­lion pa­tients who were un­in­sured in the U.S. in 2006.

There’s room to grow ““ only 22 per­cent of Amer­ic­ans are re­por­ted to be “pro­fi­cient” when it comes to their un­der­stand­ing of health care costs and ser­vices, ac­cord­ing to a U.S. De­part­ment of Edu­ca­tion study.

Low-in­come adults are dispor­por­tion­ally af­fected. Health lit­er­acy was lower on av­er­age for adults liv­ing be­low the poverty level than those liv­ing above, the DOE’s 2003 Na­tion­al As­sess­ment of Adult Lit­er­acy found. As in­come in­creased, so did health lit­er­acy.

Ra­cial and eth­nic minor­it­ies had lower av­er­age health lit­er­acy scores than White adults, the study showed. Forty-one per­cent of His­pan­ic adults and 24 per­cent of Black adults had be­low ba­sic levels of health lit­er­acy, com­pared with 9 per­cent of White adults.

Those num­bers com­ple­ment Med­PAC’s find­ings that His­pan­ic and Black pa­tients re­port poorer com­mu­nic­a­tion with pro­viders than Whites and the 2012 Na­tion­al Health­care Dis­par­it­ies Re­port which found that His­pan­ic and Black pa­tients were less likely to be asked their pref­er­ences in treat­ment de­cisions.

The health lit­er­acy prob­lem also poses a chal­lenge for the suc­cess of the Af­ford­able Care Act. Once the ex­changes open on Oct. 1, the mil­lions of new pa­tients ad­ded to the sys­tem in the com­ing years are ex­pec­ted to have high rates of health il­lit­er­acy, as many of them may not have had health in­sur­ance be­fore.

How to in­form pa­tients ““ and who to hold ac­count­able for health in­form­a­tion ““ re­mains con­tro­ver­sial. Some Med­PAC mem­bers ar­gued that health lit­er­acy wasn’t only the re­spons­ib­il­ity of the pa­tient, but also the pro­vider, to ex­plain health op­tions in ways pa­tients can un­der­stand.

“What if pa­tients were treated with dig­nity and re­spect?” said George Miller, a Med­PAC mem­ber and CEO of Com­mUnity­Care in Aus­tin, Tex. “Maybe then they’d feel em­powered.”

The con­sensus among the group was that pa­tient en­gage­ment was an im­port­ant is­sue that needs to be ad­dressed, but they were un­sure how Medi­care would play a role.

“Health lit­er­acy is a re­spons­ib­il­ity of the Medi­care pro­gram in that we should be pay­ing for care that sup­ports shared de­cision-mak­ing,” said Mary Naylor, Med­PAC mem­ber and a pro­fess­or at the Uni­versity of Pennsylvania School of Nurs­ing.

But that, com­mis­sion mem­bers said, leaves the ques­tion of how Med­PAC would meas­ure suc­cess, and provid­ing fin­an­cial in­cent­ives for pa­tient-in­clu­sion ap­peared con­ten­tious.

The com­mis­sion will wrap up its meet­ing Fri­day at the Ron­ald Re­agan Build­ing, In­ter­na­tion­al Trade Cen­ter in the Ho­ri­zon Ball­room.

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