The Wicked Problem of Health Literacy, Insurance and Decision Making

Problem Advocate, Dustin Moyer, Policy Officer, speaks about health literacy, insurance and decision making as a wicked health problem to the prospective CEOs at the Big Reveal on June 20, 2016 at the Ellie Caulkins Opera House in Denver. (Jacqueline Endsley Photography)

What do we mean by Health Literacy?

Many Americans are considered to have low health literacy rates, meaning they do not have a strong understanding of the optimal way to choose an insurance plan, how to lead a healthy lifestyle or what preventative or treatment decisions to make. It is difficult to make these decisions when patients are largely left out of the loop when it comes to understanding cost. Patients are not included in the transaction process between hospitals and insurance companies. Hospitals consistently overcharge insurance companies, leaving the patients to pay large sums of money out of pocket on top of their insurance premiums. The whole system is confusing for patients, who never know what the final bill will be until after insurance has been billed.

How does it affect society?

Quality, affordable health care is something we consider to be a basic human need, however the health care system is one of the most expensive, confusing and unreliable systems with which we all interact. Health care costs continue to rise, and the United States spends unbelievably more on healthcare than other nations. Between 1920 and 1960, many changes occurred in health care, including the emergence of insurance. Treatments were expensive and many could not afford the care they needed, so insurance companies began exchanging coverage for monthly premiums. The patients began being left out of the money side of health care and for a while this system worked. Insurance was affordable and hospitals kept costs low as of 1960. Overtime, costs have continually increased to the point that by 2024, health care costs are expected to rise to 20% of the GDP.

Why is this a wicked problem?

Health care is not one of those things people can just opt to not participate in. It affects each and every one of us, and someone has to pay for it. The problem with health literacy, insurance and decision making is a wicked one because it is composed of many complicated components. Most people, including providers, don’t understand how much procedures cost. Compounding that fact, insurance companies make deals with hospitals and providers on rates and in turn patients are required to stay in network to see cost reduction. However, sometimes a provider from another network will come in and help with a procedure and the patient, unknowingly, gets charged extra for using someone out of network. This exact phenomenon happened to a patient who planned his knee surgery at a facility in his insurance network and then received a bill for $117,000. The bill was higher than expected due to an assistant surgeon who came from out of network.

This is not an uncommon practice. How can patients, and providers for that matter, make informed decisions about their own care when it is impossible to have all the facts?

The Affordable Care Act has helped to prevent people from falling through the Medicaid gap, but it has not fixed all of the problems with health insurance and health care costs. Many can still not afford coverage and are paying penalties. Others are paying higher insurance premiums than they did before.

Let’s keep the conversation going!

In a confusing and convoluted system like our current healthcare system, it is easy to get lost and end up paying for it financially. Health care costs are too high and unpredictable. Patients need to be empowered to make informed decisions about what care they want to receive and how much they can afford to pay. Share your thoughts, ideas and articles with #101010healthliteracy #101010health

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