Consumers have lots of ways to connect with the U.S. healthcare system thanks to a multitude of websites, digital information portals and mobile apps provided by hospitals, health systems and health insurers.
But that plethora of digital tools and access to electronic information isn’t doing much to help consumers understand and navigate the highly complex healthcare system. In fact, illiteracy about healthcare among consumers is widespread and a problem that’s costing payers and providers an estimated $4.8 billion in unnecessary expenses, says new research from consulting firm Accenture.
Those costs, Accenture says, stem from confused consumers making multiple calls to customer service centers trying to understand medical terms and conditions and what’s covered—and not—by their benefits. For example, consumers with a low healthcare literacy rate, meaning as patients and plan members have difficulty in understanding doctor bills, insurance benefits, using in-network vs. out-of-network providers and related subjects, are seven times more likely to use customer support one to three times each week, and three times more likely to contact a service rep each month than consumers with a higher rate of healthcare literacy.
“Consumers with low healthcare system literacy cannot correctly identify terms related to their health insurance coverage including premium, deductible, co-payment, coinsurance and out-of-pocket maximum,” says Accenture managing director of health engagement Jean-Pierre Stephan. “They also do not understand the difference between in-network and out-of-network and how to find in-network doctors, are unaware of the benefit differences in their plan if they choose an out-of-network provider and do not know what a prior authorization is or how to get one.”
The U.S. healthcare system is so complex that more than half (52%) of consumers do not understand how to navigate it appropriately, Accenture says. These consumers struggle to make informed decisions about everything from the health plan types they choose and the premiums they pay to the doctors they see and the procedures they have done. Overall, just one in six consumers (16%) are considered to be experts in navigating the system, while one-third (33%) have no experience or proficiency with it whatsoever, Accenture says.
“Consumers are expected to understand and navigate the complex layers of a healthcare system that was not designed with them in mind,” Stephan says. “Education alone won’t solve this systemic problem, because it isn’t that Americans are failing in healthcare literacy, rather it is the complexity of the system that is failing them.”
Higher rates of healthcare illiteracy are costing healthcare companies, primarily insurers, unnecessary costs, Accenture says. For example, health insurers and employers spend about $26 more on administration fees for every consumer with low healthcare system literacy, which translates to $4.82 billion annually in administrative costs compared with $1.4 billion for more literate consumers, Accenture says.
Other report findings include:
- Roughly half (48%) of consumers who have low literacy are college-educated, and nearly all (97%) have at least a high school diploma. “If all consumers had a high understanding of how to navigate the healthcare system, health insurers could save $3.41 billion a year in administrative costs,” Stephan says.
There are multiple ways healthcare companies can work to bring healthcare illiteracy rates up and administrative costs down such as using data analytics and artificial intelligence to deliver more personalized and easier to understand medical and benefits information. “The only way to eliminate this systemic issue is advancement,” Stephan says. “Rather than forcing consumers to battle the complexities of the system, the healthcare system must design user experiences to align seamlessly with the needs, behaviors and preferences of the people it serves.”
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