Steve Leuck, PharmD
Steve Leuck, PharmD
Steve Leuck, PharmD, has been practicing both hospital and community pharmacy for over 30 years. He founded AudibleRx, in 2011, which provides Consumer Medication Information which is both Useful and Accessible. Content designed to meet health literacy guidelines. Format designed to "read along" with the audio presentation in a simple to use web application. More information at AudibleRx.org.

The Cost of Low Health Literacy

APRIL 09, 2017
We all know that lack of literacy skills can pose a challenge for anyone navigating their way through every day obstacles. Place this person in a health care environment, and the problem increases significantly. Furthermore, discharge this patient from the hospital with current standards and they are sent home with stacks of paper that promptly get set aside with many questions left unanswered.
 
On average, individuals with low health literacy can read at a fifth-grade level, while consumer medication information is written at a tenth-grade level. Health professionals regularly overestimate patients’ level of understanding and commonly do not allow ample time for questions and answers. As well, it is not uncommon for hospitals to focus on meeting the regulatory requirements of the facility by sending patients home with all the required documents, rather than assuring a complete understanding of their discharge protocol.
 
As defined by the Institute of Medicine, health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.
 
In 2003, the US Department of Education National Assessment of Adult Literacy (NAAL) measured, among other items, health literacy. Based on the results of this study, it was found that over 36% of the adult US population was either basic or below basic health literacy. In 2007, an analysis of this report, Low Health Literacy: Implications for National Health Policy, attempted to define the impact of this astounding statistic.1 The US population in 2003 was approximately 242 million adults. This corresponded to an astounding 87 million US adults with at or below basic health literacy.
 
Empirical research on a conceptual model placed the cost of low health literacy between 7-17% of all healthcare expenditures. In 2003 this dollar amount was estimated to be between $106- $238 billion annually. In the year 2015, the annual health care expenditures are estimated to be $3.6 trillion, which would provide a cost of low health literacy at approximately $612 billion dollars.
 
Let’s take this a little farther and see the impact on individual hospital admissions. The 2007 analysis calculated that individuals with low health literacy cost, on average, an additional $993 per admission. 
 
Furthermore, according to a Veterans Health Administration study, performed between 2007-2009 in northern Florida and southern Georgia, meeting the needs of those with marginal and inadequate health literacy could produce economic savings of approximately 8% of total hospital costs for this population.2 This is a savings of $2480 per patient.
 
Currently, it is estimated there are approximately 35,000,000 hospital admissions per year in the United States. 
Based on the NAAL 2003 study 36% rule, 12,600,000 of these admissions are challenged with Health Literacy. We have one study that estimates an additional $993 per admission and another study that estimates an additional $2480 per patient, so it would be considered conservative to use an average of $1000 for our calculations.
 
Based on an average of $1000 extra per admission for patients challenged with literacy, the increased cost to hospitals alone is $12.6 billion dollars per year.  Your average mid-sized community hospital that sees 5000 admissions per year spends an additional $1.8 million dollars covering the costs associated with low health literacy.
 
One small portion of the answer lies in our profession as pharmacists. Take the time to help patients understand their medications.  Listen to their concerns, address their obstacles, help patients achieve the understanding they need in order to obtain their best possible outcome of therapy.
 
 
References
1. Vernon JA, Trujillo A, Rosenbaum S, DeBuono B. Low Health Literacy: Implications for National Health Policy. 2007;
http://publichealth.gwu.edu/departments/healthpolicy/CHPR/downloads/LowHealthLiteracyReport10_4_07.pdfa.
Accessed April 3, 2017. 

 
2. Haun JN, Patel NR, French DD, Campbell RR, Bradham DD, Lapcevic WA. Association between health literacy and medical care costs in an integrated healthcare system: a regional population based study. BMC Health Services Res. 2015; 15: 249. 
 
 
 
 
 
 
 
 
 
 

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