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Health insurancy literacy |
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Written by Laurel Fantauzzo, asap
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Monday, 21 May 2007 |
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When Kit Golan took time off from school last year to work in Alabama, she maintained her Aetna health insurance back in New York.
But when the 21-year-old came down with a throat and ear infection, a doctor’s office receptionist told her she couldn’t use it. The reason: She had a personal care provider declared elsewhere.
Confused, Golan paid for the visit with a credit card.
Now, back at college in Bronxville, N.Y., Golan is enrolled as a dependent under her mother’s health care plan, UnitedHealthcare. Recently, she was billed for routine tests — then, without explanation, was sent a refund.
“I have no idea why they decided to pay,” Golan says, “or what changed.”
Health literacy — the ability to read, understand and act upon basic health information — is necessary for all patients, whatever their coverage. But in a landmark 2004 study, the Institute of Medicine found that over 90 million Americans struggle with low health literacy, finding themselves unable to decipher anything from complicated insurance forms to a doctor’s instructions on how to take a medication.
“Is that a crisis?” asks Norma Gindes, the director of volunteer initiatives for United Health Foundation, a national health services research and philanthropic organization. “Yes, I would call it a crisis. It’s a kind of silent killer, because people who don’t have that basic health information cannot manage their illnesses, whether acute or chronic.”
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TOUGH INITIATION
For young adults making the transition from college to the working world, health literacy may seem far out of reach.
After college, Sophia Park, 21, a Moorpark, Calif., student with schizoaffective disorder, enrolled in MediCal, state-funded insurance for people over 18 with disabilities. But due to fear and confusion, she often bypasses the health care system altogether.
“If I’m sick with the flu or something and it’s not life-threatening, I go without seeing the doctor because taking the steps to find out which doctors I could see is confusing,” Park says. “And the doctors I am able to see under the MediCal plan are usually terrible, unqualified, uncaring and hasty.”
Helen Osborne is the founder of Health Literacy Consulting, a firm that teaches organizations how to communicate health information in ways patients and families can understand. She was inspired to study health literacy after working as an occupational therapist at a community-based hospital in Boston in the seventies.
Observing how most of her patients kept suffering from the same treatable ailments again and again, she said, “No wonder — they can’t follow all these directions!
Maybe it’s not them, maybe it’s me!”
Osborne says that for young adults transitioning from their parents’ health care coverage, maneuvering the system can be intimidating.
“There are many concepts many young adults may never have considered — not just difficult words, but difficult concepts as well. Copay, caps, maximums, deductibles, premium costs, formularies,” she says. “It’s probably a population that isn’t necessarily sick right now. You feel invulnerable. But we all are at risk and we all have long-term decisions to make.”
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THE REMEDY
While they work to make institutional changes, Gindes and Osborne detail five ways young adults can improve their own health literacy skills, starting with a routine checkup at the doctor’s office:
1. Write down your questions before you go to the doctor. “Appointments are really short — there’s no way around that,” says Osborne. “Young people can set their agenda along with their health care providers.”
2. Write down the doctor’s answers.
3. Upon receiving treatment instructions, repeat your understanding of those instructions out loud for the doctor to hear. “That gives that doctor the opportunity to clarify what your understanding is, and if you have misunderstood it gives the doctor the opportunity to clarify that,” says Gindes.
4. Take someone you trust with you into the doctor’s office. “A lot of times patients get nervous, they get rattled — even the most educated people have those reactions,” says Gindes. “Some of the news they’re going to get is not necessarily what they’re prepared for.” A trusted friend or loved one can advocate for a patient during times of confusion or crisis.
5. Create your own personal health record. “Keep track of your inoculations, your appointment dates, and your test results,” says Osborne. If a doctor asks questions about your medical history, it can be helpful to have a document to look up instead of relying on memory during a potentially nerve-racking moment. “Once people take off their clothes, it’s hard to remember and it’s hard to think,” says Osborne.
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THE WEB IS YOUR FRENEMY
Since young adults are more inclined to use the Internet, Osborne cautions that many sites may offer inaccurate information, sometimes to sell a product. For a preliminary explanation of symptoms, she recommends the Web sites of Medline Plus, the Centers for Disease Control and Prevention and the National Institutes of Health. “I would go to those rather than just Googling whatever topic comes your way,” she says.
In understanding insurance issues, Gindes counsels persistence in following up with a company’s human resource department, an employer or a representative from the insurance company itself.
“I would hope that the Web sites or the health plan could explain it,” she says. She acknowledges, though, that seeking coverage information can be frustrating. “I’m not real optimistic about this. I think the insurers haven’t caught up with that.”
Even as some young adults flounder in their understanding of health care, others have found ways to maneuver it, often encouraged by experienced family members.
Because his mother was a hospital social worker, Holden McNeely, a 23-year-old administrative assistant in New York City, was not overwhelmed when his employer switched insurance carriers three months ago.
“Some packets were more confusing than others,” he said, “but I got a pretty good handle on it. I feel just fine about it, because my mother is a wealth of knowledge on the subject.”
For those young adults who do not have a knowledgeable parent available, Gindes says there is hope.
“You have to grab that power and get your questions answered — if you don’t like something, there often are choices.”
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asap contributor Laurel Fantauzzo is a writer based in New York. She can be reached at
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