Finding meaning in health care’s complex language

As many as 9 out of 10 adults may lack the ability to adequately understand the language of health care.

Finding a new doctor. Taking medicine as prescribed. Following instructions for what to do before and after surgery.

From simple to complex, most parts of the health care process require an ability to grasp health care terms. Yet as many as 9 out of 10 adults may lack the ability to understand the language of health care adequately, preventing them from managing their health care needs, according to an assessment by the U.S. Department of Education.

That includes filling out often complex forms, finding doctors and health services, sharing personal health history with doctors, following self-care steps for managing disease and more.

Some people may lack health literacy. They often:

  • Don’t understand the causes of disease
  • Find it hard to see how factors such as food choice and exercise impact their health
  • Struggle with managing ongoing health problems such as high blood pressure, diabetes or asthma
  • Skip important preventive care and health tests, such as flu shots and mammograms
  • Are sicker when they first seek care
  • Use more emergency services and end up in the hospital more often

On top of that, studies show that many people also don’t understand insurance terms, the basics of health insurance or how to shop for it.

Gaining an understanding of what their plan covers and how insurance works – from paying premiums to using certain provider “networks,” to getting referrals and approvals – is vitally important for people who may not have had health insurance before.

The number of people who shop for health plans on their own surged because of the health insurance marketplaces created by the Affordable Care Act. In Texas, for example, the number of people who bought individual health plans increased 78 percent from 2013 to 2015, as reported in a study from Rice University’s Baker Institute for Public Policy and the Episcopal Health Foundation.

For many, it was their first time to have insurance. These people were far less likely to understand basic health insurance terms like premium, copayment and deductible. They also had more difficulty understanding how to use their health plans compared to people with employer-based health plans or government programs like Medicare of Medicaid.

Using simple language

Implementation of the Affordable Care Act spurred steps toward more reader-friendly and easier to understand communications. Several Affordable Care Act provisions directly acknowledged the need for greater attention to health literacy, with requirements to communicate health and health care information clearly.

The American Association of Health Insurance Plans and the National Consumers League joined forces to create easy-to-use information for consumers. Called MyHealthPlan.Guide, the online guide provides definitions of health insurance terms, health appointment checklists and other handy tools. Others, including the federal government, have created similar resource sites.

Literacy is key to seeking health care and complying with treatment and prevention.

For insurers across the U.S., this meant looking at consumer communications in a new way. It included simplifying language in many communications to members and others. Reviewing member education materials and rewriting at an easier reading comprehension level – usually around the sixth-grade reading level — was key to consumer comprehension. Even using simple graphics played a role in helping make health insurance more approachable for those wary of insurance.

“We want people to understand what they are reading so that they understand how insurance works – and their options,” says Laura Squires, a corporate communications manager for the Blue Cross and Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma and Texas. Leading up to the 2014 launch of the health insurance marketplaces, her team coordinated the literacy review of print, social media and web communications targeted at general consumers, created consumer education materials for the newly insured, and helped launch a website just for consumer education as part of the Be Covered community outreach program.

At the same time, another company team reviewed some 500 variations of letters that go to members to explain how their health care claims are processed. The goal was to create a friendly design with plain language to make the pieces easier to read and more engaging. Many of the letters had the comprehension measure reduced from a tenth-grade to sixth- to- eighth grade reading level. A simpler, more conversational approach was crafted to provide an improved member experience.

“We want our members to understand in five seconds why we are sending the letter and what their – and our – next steps are,” says Lisa Byrd, senior director of business operations and regulatory communications.

Making health care and health insurance something that can be understood isn’t easy. Health terms and insurance terms, such as the names of diseases or phrases like “out-of-pocket maximum” are what they are. How you frame them in the larger communication, using context and examples, may simplify the language so that more consumers may understand the material.

Still, health care providers and insurers struggle with communicating effectively with people limited reading or writing skills. Literacy is one socio-economic indicator used to measure how well someone manages their health.

“Research done over 20 years ago linked the ability of parents and children to read to social welfare and health,” says Dr. Candace Kendle, an internationally known clinical researcher.

Kendle says she grew up in a family that read, a tradition started by her grandmother while raising her nine children. Each night, her grandmother would read aloud to the whole family. She had only graduated from eighth grade, and her husband’s formal education ended after grade school.

Of the nine, only the oldest child would go on to graduate from college. Finances were too tight from the Great Depression and World War II for the others. But they were all readers. Kendle’s mother, now 97, was the baby of that family. She passed along the reading aloud tradition to her own family.

Kendle never forgot the lesson. She went on to run a successful global clinical research company. Five years ago, she helped launch a nonprofit called Read Aloud 15 MINUTES to encourage parents to read daily to their children.

“Literacy is key to seeking health care and complying with treatment and prevention,” Kendle says. “It is hard to stay well if you cannot amass knowledge around wellness.”

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