Health Insurance And Insights From Health Literacy

Since the passage of the Patient Protection and Affordable Care Act (ACA), health care reform has created major changes in the U.S. health care system. The ACA has brought millions of people into the system who had no previous access, and many of these newly enrolled individuals have had limited experience navigating the complex and complicated U.S. health system. In July 2016 the National Academies of Sciences, Engineering, and Medicine convened a public workshop to examine health insurance through the lens of health literacy, focusing on literacy related barriers to information and coverage as well as on possible solutions. Participants discussed the role of health literacy in accessing health care and remaining in treatment; delivery and financing system reforms that affect organizational health literacy; and quality and equity considerations. This publication summarizes the presentations and discussions from the workshop.

Implementation of the Affordable Care Act (ACA) of 2010 will result in significant changes to the U.S. health care system. Among its many provisions, the ACA will extend access to health care coverage to millions of Americans who have been previously uninsured. Many of the newly eligible health insurance consumers will be individuals of low health literacy, some speakers of English and others more comfortable using languages other than English. Health insurance terms such as "deductible," "co-insurance," and "out-of-pocket limit" are difficult to communicate even to those with moderate-to-high levels of health literacy and so health exchanges will face challenges as they attempt to communicate to the broader community. In addition to having to convey some of these basic, and yet complex, principles of insurance, state exchanges will be attempting to adapt to the many changes to enrollment and eligibility brought about by ACA. The Institute of Medicine (IOM) convened the Roundtable on Health Literacy that brings together leaders from the federal government, foundations, health plans, associations, and private companies to discuss challenges facing health literacy practice and research and to identify approaches to promote health literacy in both the public and private sectors. The roundtable sponsored a workshop in Washington, DC, on July 19, 2011, that focused on ways in which health literacy can facilitate state health insurance exchange communication with potential enrollees. The roundtable's workshop focused on four topics: (1) lessons learned from existing state insurance exchanges; (2) the impact of state insurance exchanges on consumers; (3) the relevance of health literacy to health insurance exchanges; and (4) current best practices in developing materials and communicating with consumers. Facilitating State Health Exchange Communication Through the Use of Health Literate Practices summarizes the presentations and discussion that occurred during the workshop. The report provides an overview of health insurance exchanges, presents evidence on the extent to which consumers understand underlying health insurance concepts, and describes the relevancy of health literacy to health insurance reform and how health literacy interventions can facilitate the implementation of health insurance reforms. The report also provides a review of best practices in developing materials and communicating with consumers, and concludes with reflections on the workshop presentations and discussions by members of the roundtable and its chair. Further information is provided in the appendixes, the workshop agenda (Appendix A), workshop speaker biosketches (Appendix B), and testimony provided by the organization America's Health Insurance Plans (AHIP) (Appendix C).

“Health literacy is the ultimate global currency of health and well-being. Without health literacy, medicine fails, public health fails, and people pay the cost for these failures with their lives. As this book goes to press, the world is confronted by the COVID-19 pandemic. Improving health literacy becomes increasingly important if we are to successfully confront the challenges that stress our systems of medicine and public health like never before.” (Richard H. Carmona, M.D., M.P.H., FACS, former Surgeon General of the United States, in his foreword to this book.) Two years ago, HTI published the book Health Literacy: New Directions in Research, Theory and Practice. Together with that earlier volume, this book: Health Literacy in Clinical Practice and Public Health: New Initiatives and Lessons Learned at the Intersection with other Disciplines, strives to enumerate and expand our understanding of the multidisciplinary connections which underpin the field of health literacy. The book’s balance between research and practice is a response to the feedback the editors received about the previous publication, which focused more on HL theory and research. With reports of specific health literacy research initiatives and interventions, particularly in clinical practice and public health, the book covers contemporary health literacy research and practice and is divided into three sections. Section one explores health literacy’s capacity to foster progress in clinical practice and public health; section two provides insights into health literacy initiatives and lessons learned from diverse healthcare stakeholders; and section three examines health literacy’s similarities with – and differences from – related health research disciplines. The book sets the practice and research of health literacy on an evidence-based, thoughtful, effective, efficient, and applied course. As Dr Richard Carmona says in his foreword: “It is enthusiastically recommended for all health and medical practitioners and researchers.”

Health literacy is the degree to which one can understand and make decisions based on health information. Nearly 90 million adults in the United States have limited health literacy. While poor health literacy spans all demographics, rates of low health literacy are disproportionately higher among those with lower socioeconomic status, limited education, or limited English proficiency, as well as among the elderly and individuals with mental or physical disabilities. Studies have shown that there is a correlation between low health literacy and poor health outcomes. In 2010, President Obama signed the Affordable Care Act designed to extend access to health care coverage to millions of Americans who have been previously uninsured. Many of the newly eligible individuals who should benefit most from the ACA, however, are least prepared to realize those benefits as a result of low health literacy. They will face significant challenges understanding what coverage they are eligible for under the ACA, making informed choices about the best options for themselves and their families, and completing the enrollment process. Health Literacy Implications for Health Care Reform explores opportunities to advance health literacy in association with the implementation of health care reform. The report focuses on building partnerships to advance the field of health literacy by translating research findings into practical strategies for implementation, and on educating the public, press, and policymakers regarding issues of health literacy.

Available Open Access under CC-BY-NC licence. Health literacy addresses a range of social dimensions of health, including knowledge, navigation and communication, as well as individual and organizational skills for accessing, understanding, evaluating and using information. Particularly over the past decade, health literacy has globally become a major public health concern as an asset for promoting health, wellbeing and sustainable development. This comprehensive handbook provides an invaluable overview of current international thinking about health literacy, highlighting cutting edge research, policy and practice in the field. With a diverse team of contributors, the book addresses health literacy across the life-span and offers insights from different populations and settings. Providing a wide range of major findings, the book outlines current discourse in the field and examines necessary future dialogues and new perspectives.

The field of health literacy has evolved from one focused on individuals to one that recognizes that health literacy is multidimensional. While communicating in a health literate manner is important for everyone, it is particularly important when communicating with those with limited health literacy who also experience more serious medication errors, higher rates of hospitalization and use of the emergency room, poor health outcomes, and increased mortality. Over the past decade, research has shown that health literacy interventions can significantly impact various areas including health care costs, outcomes, and health disparities. To understand the extent to which health literacy has been shown to be effective at contributing to the Quadruple Aim of improving the health of communities, providing better care, providing affordable care, and improving the experience of the health care team, the National Academies of Sciences, Engineering, and Medicine convened a public workshop on building the case for health literacy. This publication summarizes the presentations and discussions from the workshop, and highlights important lessons about the role of health literacy in meeting the Quadruple Aim, case studies of organizations that have adopted health literacy, and discussions among the different stakeholders involved in making the case for health literacy.

In this anthology of health literacy, drawing on New Social Literacy studies and contemporary debates on equity, we discuss health literacy within German regional and cultural contexts as well as in selected non-European regions, such as in Asia and South America. Topics include unique reviews on health literacy, new empirical results on different population groups, in-depth ethnographic insights into social contexts, interventions intended to improve health literacy, and innovative theoretical dialogs. The discussions within this book provide new ideas and intriguing new results, also shedding light on the explanatory power of the health literacy concept as well as its boundaries.

In 2004, the Institute of Medicine released Health Literacy: A Prescription to End Confusion, a report on the then-underappreciated challenge of enabling patients to comprehend their condition and treatment, to make the best decisions for their care, and to take the right medications at the right time in the intended dose. That report documented the problems, origins, and consequences of the fact that tens of millions of U.S. adults are unable to read complex texts, including many health-related materials, and it proposed possible solutions to those problems. To commemorate the anniversary of the release of the 2004 health literacy report, the Institute of Medicine's Roundtable on Health Literacy convened a 1-day public workshop to assess the progress made in the field of health literacy over the past decade, the current state of the field, and the future of health literacy at the local, national, and international levels. Health Literacy: Past, Present, and Future summarizes the presentation and discussion of the workshop.