Illiteracy as a Social Determinant – and Related Healthcare Costs

Approximately $230 billion a year in healthcare costs are directly related to illiteracy and the social factors associated with illiteracy.

“Illiteracy” is such a broad term. It states a fact, but the underlying causes and far-reaching life and generational impacts are less well-stated.

The problems are hiding in statistics from multiple organizations. Federal and state publications, juvenile and adult penal system statistics, morbidity and mortality statistics, figures on unemployment, obesity, education, physician reports of non-compliant patients, healthcare costs – the list goes on. I should have recognized the tip of the iceberg in the 1980s, when my husband, a technical writer for how to operate one of our missile systems, complained that everything had to be written at a fifth-grade level so the soldiers could figure out how to launch the missile. I wondered, how hard to comprehend are fifth-grade words? Just a few examples from current educational websites include: alert, evade, painstaking, accommodate, premature, experience. Easy words for us, perhaps but not for the illiterate.

Before we can fully understand the healthcare ramifications, we need to look at a much broader picture. Although statistics vary a small amount, depending on the source, they are mostly very consistent. Seventy-five percent of state prison inmates are classified as low-literate, defined as an inability to read, write, and use numbers effectively. More than 30 million U.S. adults cannot read, write, or do math above a third-grade level, and 21 percent read below a fifth-grade level. Nineteen percent of high school graduates cannot read. Children who have parents with low literacy have a 72 percent chance of having the lowest level. Currently, the average reading level in the U.S. is eighth-grade. However, some cities have been reported as having a 70 percent illiteracy level.

The Patient Protection and Affordable Care Act (PPACA) defines health literacy as the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate decisions. Based on the above statistics, there is a massive chasm between patient understanding of their healthcare diseases and conditions, needs, and management, and the instructions and materials upon which they must rely.

The American Academy of Family Physicians published a piece indicating that most healthcare patient instructions are written at a 10th-grade reading level. Potentially, providers are giving such reading materials to patients who are capable of interpreting and understanding only at a fifth- or third-grade level. Although many facilities do have grade-appropriate materials and even pictures, many illiterate patients hide it well. In the Physicians Foundation 2018 Physician Survey, 52 percent of physicians reported that they see patients affected by a social determinant of health (SDoH). In aggregate, from most to least compliant, about 87 percent of physicians reported seeing some patients who do not consistently follow their treatment regimens.

Certainly, the cost of medication, cost of care, easy ability to travel and keep appointments, childcare, work requirements, and other variables apply here. However,  I must question how much of this reported non-compliance is directly related to the inability to comprehend the care advice. I also want to stress that this is not a limiting factor only to those with illiteracy. Many senior patients, and just plain laypeople, do not understand medical language. Medicine is a foreign language patients try to interpret. Unfortunately,  their interpretation is frequently wrong. One physician stated that there was a 50/50 chance the patient would do as instructed. Other physicians opined that 30 minutes after leaving an appointment, the patient could not explain or correctly restate the visit, diagnosis, and instructions. Although estimates vary, approximately $230 billion a year in healthcare costs are directly related to illiteracy and the social factors associated with illiteracy. Fully half of Americans do not read well enough to comprehend their health information. The results are preventable hospital admissions, emergency department visits, medication errors, and patients lost to follow-up and disease management.

We cannot fix this healthcare cost until we fix the illiteracy problem, and providers’ ability to correctly assess their patients’ levels of comprehension. At the very least, we need to convey and provide instructions at appropriate patient understanding levels. Just as we provide Spanish or Russian or Chinese interpretations, we need to provide information a third-grader or fifth-grader would be able to follow correctly, when necessary.  I do not think it is too hard to say, “take your green pill every day when you eat lunch.” We can even draw a picture.

P.S. This article was written at a 12th-grade reading level.

Programming Note:

Holly Louie co-hosts Talk Ten Tuesday today with Chuck Buck, 10-10:30 a.m. EST.

Facebook
Twitter
LinkedIn

Holly Louie, RN, BSN, CHBME

Holly Louie, a member of the ICD10monitor editorial board, is a former compliance officer and past president of the Healthcare Business and Management Association. Louie has been a guest cohost on Talk Ten Tuesdays with Chuck Buck.

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

2025 Coding Clinic Webcast Series

2024 ICD-10-CM/PCS Coding Clinic Update Webcast Series

Uncover critical guidance. HIM coding expert, Kay Piper, RHIA, CDIP, CCS, provides an interactive review on important information in each of the AHA’s 2025 ICD-10-CM/PCS Quarterly Coding Clinics in easy-to-access on-demand webcasts, available shortly after each official publication.

April 14, 2025

Trending News

Featured Webcasts

Audit-Proof Your Wound Care Procedures: Expert Insights on Compliance and Risk Mitigation

Audit-Proof Your Wound Care Procedures: Expert Insights on Compliance and Risk Mitigation

Providers face increasing Medicare audits when using skin substitute grafts, leaving many unprepared for claim denials and financial liabilities. Join veteran healthcare attorney Andrew B. Wachler, Esq., in this essential webcast and master the Medicare audit process, learn best practices for compliant billing and documentation, and mitigate fraud and abuse risks. With actionable insights and a live Q&A session, you’ll gain the tools to defend your practice and ensure compliance in this rapidly evolving landscape.

April 17, 2025
Utilization Review Essentials: What Every Professional Needs to Know About Medicare

Utilization Review Essentials: What Every Professional Needs to Know About Medicare

Dr. Ronald Hirsch dives into the basics of Medicare for clinicians to be successful as utilization review professionals. He’ll break down what Medicare does and doesn’t pay for, what services it provides and how hospitals get paid for providing those services – including both inpatient and outpatient. Learn how claims are prepared and how much patients must pay for their care. By attending our webcast, you will gain a new understanding of these issues and be better equipped to talk to patients, to their medical staff, and to their administrative team.

March 20, 2025

Rethinking Observation Metrics: Standardizing Data for Better Outcomes

Hospitals face growing challenges in measuring observation metrics due to inconsistencies in classification, payer policies, and benchmarking practices. Join Tiffany Ferguson, LMSW, CMAC, ACM, and Anuja Mohla, DO, FACP, MBA, ACPA-C, CHCQM-PHYADV as they provide critical insights into refining observation metrics. This webcast will address key issues affecting observation data integrity and offer strategies for improving consistency in reporting. You will learn how to define meaningful metrics, clarify commonly misinterpreted terms, and apply best practices for benchmarking, and gain actionable strategies to enhance observation data reliability, mitigate financial risk, and drive better decision-making.

February 25, 2025
Navigating the 2025 Medicare Physician Fee Schedule: Key Changes and Strategies for Success

Navigating the 2025 Medicare Physician Fee Schedule: Key Changes and Strategies for Success

The 2025 Medicare Physician Fee Schedule brings significant changes to payment rates, coverage, and coding for physician services, impacting practices nationwide. Join Stanley Nachimson, MS., as he provides a comprehensive guide to understanding these updates, offering actionable insights on new Medicare-covered services, revised coding rules, and payment policies effective January 1. Learn how to adapt your practices to maintain compliance, maximize reimbursement, and plan for revenue in 2025. Whether you’re a physician, coder, or financial staff member, this session equips you with the tools to navigate Medicare’s evolving requirements confidently and efficiently.

January 21, 2025

Trending News

Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more

Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!

CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24