Black Jet Theory – Volume 2020-14 – Health Literacy – the Ultimate Acceptance of Responsibility by the Patient and the Provider
July 31, 2020 by Marshall Snipes
What is health literacy? “The Patient Protection and Affordable Care Act of 2010, Title V, 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 health decisions.”[1]
The federal government understands “the need to make health literacy a public health priority”.[2] Accordingly, the National Action Plan to Improve Health Literacy was established in 2010 to attack the problem of low rates of health literacy in the United States.
“One study estimates the cost of limited health literacy to the nation’s economy to be between $106 and $236 billion U.S. dollars (USD) annually. When one accounts for the future costs that result from current actions (or lack of action), the real present-day cost of limited health literacy might be closer to $1.6 – 3.6 trillion USD.”[3] “Only 12 percent of adults in the United States have a high level of health literacy, according to the National Assessment of Adult Literacy. In other words, nearly nine out of ten adults lack the skills needed to fully manage their health care and prevent disease. Low literacy has been linked to poor health outcomes, higher rates of hospitalizations, less use of preventive services, minimal prescription and care plan adherence, and death. Additionally, these all lead to higher health care costs,”[4] and 50% of patients are uncertain of how to care for themselves after they leave the doctor’s office.[5]
As alarming as these statistics are, it makes perfect Black Jet Theory[6] sense that the average American does not have a high health literacy IQ. “We are dealing with a relatively uninformed consumer who generally places total faith in their referring physician. The ultimate question we all have for our doctor is – if this was your mother what would you do?”[7] Unfortunately, the incentives in the healthcare system do not allow for proper education of the patients by the providers. “… the physician’s incentive system is exactly opposite of the patient’s best interest. Patients want the most time with their physician. The doctor’s incentive is to spend as little time as possible and then move on to the next patient.”[8]
One’s health and the healthcare he or she receives is complicated and intimidating to most people. Isn’t that why we have doctors in the first place? Of course, the answer to that question is yes. However, the more complex question becomes, who is responsible for a person’s health status? Is it the doctor whose incentives are misaligned or is it the individual whose responsibility it is to look out for themselves? Unfortunately, in our fast food, quick fix culture, we have become predisposed to deferring that responsibility to others. The Black Jet common sense approach would seem to dictate that individuals should take responsibility for their own health status. Further, that would not seem possible without cooperation and input from the medical establishment, primarily the physicians who treat patients on a daily basis.
So why hasn’t the National Health Plan to Improve Health Literacy worked? Changing behavior without incentives is very difficult. While the National Plan is comprehensive and very detailed, the success is based on the individual’s cooperation without effective incentives. Some would argue that better health would be enough to motivate one to action. That has not been the case. Others would argue that its none of anyone’s business what decisions should be made about personal behavior. That argument ignores the costly impact of the system.
Back to our definition of health literacy. It is the individual patient’s understanding of basic health information that defines health literacy and results in better decisions and outcomes. That makes common sense. The more information you have, the better decisions you make. There are many examples of this adage in everyday life. If someone else make those decisions for you, then you have deferred to the misaligned and costly economic system that unfortunately exists today.
The solution is simple in theory, but not so simple in reality. Everyone needs to be better informed about the medical issues they face, including the causes of the problem, the alternative solutions and most importantly the risks inherent in any treatment plan. Too often alternative solutions are not explained or if they are, the patient is simply unwillingly to make the effort to change behavior. It’s too easy. As Larry the Cable Guy says – to just take one pill each morning. Changing behavior is hard and physicians can only go so far in demanding change. It’s easier for the physician to just prescribe a pill. Too often the risks are not properly explained. There is risk in every medical treatment plan and it’s incumbent upon every provider to explain the risk so every patient understands it. Not everyone can go to medical school so where is the trade-off? What can be done to help the patient make better informed decisions?
Jeff Greene, CEO of MedEncentive, believes the solution to inadequate health literacy is “information therapy,” defined as “providing people with the right information, at the right time, in the right way so they are more knowledgeable and motivated to make better decisions about their health behaviors and medical treatment options.”[9] MedEncentive offers a web-based “reward-induced information therapy” system that aligns patient-doctor incentives to promote health literacy and compliance, which has been proven to improve health and lowers costs.[10]
You would never buy a car or a house without checking the facts, understanding the pluses and minuses of the alternatives and scrutinizing the costs. Why should health care be any different? Isn’t our health more important than buying a car?
So, what’s the answer? Common sense would seem to point us in the direction of changing the incentives. If the current incentive system is misaligned, then what should change? (1) Physicians and patients should be financially motivated to achieve a higher literacy IQ based on the corresponding results of improved health status. This would require a significant change for those who pay for medical care, the government, the insurance companies, and employers. (2) Both physicians and patients should be financially motivated to use existing tools to promote literacy and measure results. While patients and physicians should be motivated simply by improving health status, we all know it doesn’t work that way. Sadly, if we want change, financial incentives have to be part of the solution. This would require significant changes by the physicians and the patients. (3) Education must include information about alternative treatments to avoid costly medical procedures. And (4) the patient must understand the risks that are inherent in any medical treatment plan.
Don’t take my word for it, think for yourself.
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[1] Centers for Disease Control and Prevention website. https://www.cdc.gov/healthliteracy/learn/index.html.
[2] U.S. Department of Health and Human Services website. https://health.gov/sites/default/files/2019-09/Health_Literacy_Action_Plan.pdf. Page iii.
[3] Ibid. Page 10. And, Vernon, J. A., Trujillo, A., Rosenbaum, S., & DeBuono, B. (2007). Low health literacy: Implications for national policy. Retrieved November 30, 2008, from http://www.gwumc.edu/sphhs/departments/healthpolicy/chsrp/downloads/LowHealthLiteracyReport10_4_07.pdf
[4] Vecchiarelli J. (January 30, 2018). 4 Cold Hard Facts About Health Literacy. Retrieved July 28, 2020 from https://proliteracy.org/Blogs/Article/308/4-Cold-Hard-Facts-About-Health-Literacy
[5] Medencentive website. https://www.medencentive.com/
[6] Snipes M. The Black Jet Theory is “the notion that most of what currently happens, when viewed through the filter of common sense and critical thinking, leads to a different conclusion, than the widespread view of current thinking by those who control the dissemination and content of information (academia, the media, politicians and other “experts”). Black Jet Theory – Volume 2020-1, May 1, 2020. Article upon request [email protected].
[7] Hupfeld S. Political Malpractice. (2012). Page 47.
[8] Ibid. Page 48.
[9] “Information therapy” Wikipedia: The Free Encyclopedia. Wikimedia Foundation, Inc. 25 March 2020, https://en.wikipedia.org/wiki/Information_therapy
[10] Greene 1C, Haun JN, French DD, Chambers SL Roswell RH. Reduced Hospitalizations, Emergency Room Visits, and Costs Associated with a Web-Based Health Literacy, Aligned-Incentive Intervention: Mixed Methods Study. J Med Internet Res 2019;21(10):e14772