Ben Hartman, MD

Healthcare Reform and You

A consumer’s guide to the Affordable Care Act

Do Your Homework!: Be Health Literate

Published Jan 9, 2014

Forty million, previously uninsurable, Americans now have coverage. But are they health literate? Do they have “the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions?”

Here’s an example of a health-literate citizen. A 30-year-old man with Crohn’s Disease moved to a new town for work. His employer has less than 50 employees and doesn’t offer health coverage.

He reviews the exchange plans, and selects a health maintenance organization (HMO) plan to cover his current and future medical needs. Crohn’s is a chronic disease that requires constant monitoring, treatment, and, in some cases, surgery. He, like many Crohn’s patients, has unpredictable, sometimes severe, acute flare-ups that land him in the hospital. He relies on a variety of medications that his plan must cover.

He did his homework and understands the pertinent terminology and concepts. He purchased a silver exchange plan with a $400-per-month premium $3,000 deductible, 70:30 co-insurance, $10-$20 co-pay, and nation-wide coverage, in case he has a flare-up while traveling.

He then had to choose a primary care provider (PCP) − a family medicine, internal medicine, or pediatric physician − because HMOs require enrollees to select an in-network PCP. The PCP must provide him a referral before receiving care from a specialist (this requirement is usually waived in emergency situations)

He chose a PCP who has treated Crohn’s patients in the past and has a history of working with local gastrointestinal (GI) specialists and surgeons. He did this because he understands the importance of teamwork, and has seen the negative consequences of disjointed care.

So how did he go about selecting a PCP? He asked his previous PCP and GI specialist, co-workers, human resources staff, and contacted the local hospitals’ GI department to ask which PCPs they recommend. Once he decided on a team, he verified their credentials at an online site like the U.S. News Doctor Finder site

As you can see, it’s a stepwise process. He navigated the system smoothly because he was health literate. But what about a new insurance enrollee or someone who’s always had insurance taken care of through their employers or parents? How does the Affordable Care Act (ACA) improve their health literacy? Unfortunately, it doesn’t do much. According to a 2011 Institute of Medicine (IOM) report, “there are few potent levers for health literacy, there is no forceful legislative language, no regulatory mandates, and no designated resources,” under ACA.

Over the past few years, leading government and non-government organizations have studied this issue in depth and written about it. Most of the reports are lengthy, vague, and lofty in their goals or recommendations, written for a medical audience, scattered among different organizations, and, most importantly, don’t offer practical ways to disseminate “basic understanding.” In fact, I don’t think they even take the first step, which is to define the term”basic understanding.” Once they do that, they can determine the essential information needed to become health-literate.

How about taking a lesson from the hand-washing campaign implemented to reduce hospital- and non-hospital-borne infections? You see their one-page, step-by-step, instruction sheets, along with hand sanitizer, everywhere: in hospitals, public restrooms, cafeterias, airports, schools. The posters are attention-grabbing, readable, and simple.

The government should do the same with a health-literacy campaign. Determine what information is required for a “basic understanding” and design a simple, step-by-step, easy-to-comprehend, one-page document. Send it to homes, hospitals, clinics, community centers, public libraries, universities, wherever. It’s a relatively cheap and practical fix. If it fails, try something else. Keep trying until something does work.


I look forward to hearing from you.

– Ben

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