The rush to create consumer-directed health plans might not go as far as some hope, based on findings in a recent study by the Institute of Medicine that says that about 90 million people have difficulty reading and understanding medical information.

Consumer-directed plans typically have deductibles as high as several thousand dollars, health reimbursement accounts, and a strong focus on Internet-based health information tools.

"The public's ability to understand and make informed decisions about its health is a frequently ignored problem that can have a profound impact on individuals' health and the health care system," says David A. Kindig, MD, PhD, the chairman of the IOM committee that wrote the report, Health Literacy: A Prescription To End Confusion. "Most professionals and policy makers have little understanding of the extent and effects of this problem."

The IOM defines health literacy as more than just a measure of reading skills. It also includes writing, listening, speaking, arithmetic, and conceptual knowledge. The organization wants all players in the system to fight the problem. Health plans, for instance, should establish ways to communicate clearly all relevant health information.

It notes that people are "assuming new roles in seeking information, measuring and monitoring their own health, and making decisions about insurance and other options for care."

It's been assumed that just how well those tasks are performed has something to do with the socioeconomic status of the patient.

For instance, James Robinson, PhD, MPH, professor of health economics at the School of Public Health at the University of California at Berkeley, noted in an article in 2001 in the Journal of the American Medical Association that "Consumers vary enormously in their financial, cognitive, and cultural preparedness to navigate the complex health care system. The new paradigm fits most comfortably the educated, assertive, and prosperous and least comfortably the impoverished, meek, and poorly educated."

However, Health Literacy: A Prescription To End Confusion says that even educated patients can be deemed to exhibit health illiteracy.

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