Guest Article

Employees Can't Use Health Information They Can't Understand

by Mark Hochhauser, Ph.D.
Readability Consultant

No one is happy about the increasing costs of employee health care coverage; not health plans (which must raise premiums and co-pays and lower reimbursement to stay competitive), not employers (who have to pay more for employee healthcare coverage), and certainly not employees (who have to pay higher premiums and co-pay costs and may be limited in their choices of doctors and hospitals).

One widely promoted strategy for reducing healthcare costs is to give employees more health information so they can make better health care decisions about their own health behaviors, choice of health plans, doctors, and hospitals. The assumption behind this strategy is that more information = better choices. Does that strategy work?

Incomprehensible health information

Unfortunately, health literacy research shows that instead of being understandable (and usable), most health-related information is incomprehensible (and therefore unusable). My readability research shows that summary plan descriptions of health coverage, informed consent forms, HIPAA privacy notices, patient bills/explanations of benefits, patient rights' documents, managed care/HMO report cards, advance directives and brief summaries in direct-to-consumer drug ads are written not in plain English but in a confusing combination of legal and medical jargon that most employees just can't understand.

A large gap exists between the level at which health information is written and the literacy skills employees actually have to understand that information. Why do health organizations distribute health information that's written at a college-to-graduate school reading level if health literacy researchers recommend that materials for the public be written at about a junior high reading level? Employees aren't going to read health information that requires them to use dictionaries, glossaries of managed care terms, and medical and legal dictionaries to make sense of those materials. Reading health information shouldn't be a code-breaking exercise.

If employees can't understand the health information they're given, they can't use that information to make better health decisions. In other words, incomprehensible health information is irrelevant, and will probably have little or no impact on your employees' health decisions. What are the costs of sending out information your employees can't read or use: Less healthy behaviors? Poorer health care choices? More phone calls to human resources because they don't understand their benefits? Lack of trust?

Health problems don't rest only with noncompliant or unmotivated patients, but with those managed care plans, HMOs, hospitals, clinics and doctors that give patients incomprehensible health information and then blame the patients for not being healthier! Expecting patients to take more responsibility for their health is reasonable. But, does incomprehensible health information help or hinder a patient's personal responsibility?

Why patients don't understand their rights

As a patient, when was the last time you received something from your health plan or hospital that was easy-to-read? The last time I went to a clinic in Minnesota, I was given a copy of Minnesota's "Patient's Bill of Rights," which included my "Rights Under Federal Law," both of which are incomprehensible. The "Patient's Bill of Rights" was written at about a grade 19 (third-year graduate school) reading level, and your "Rights Under Federal Law" was written at about a grade 17 (first-year graduate school) reading level. Having a PhD (20 years of education) didn't help much. I found they hard to read and understand. There's an old joke: There are two problems with legal writing; the style and the content. But it's no joke when you have to read important health information that's written in a style that no one can understand. My Minnesota "rights" were written by the Minnesota Legislature, which and apparently concluded that as long as Minnesotans were told about their rights it didn't matter if they could actually understand them!

Add to patient rights' summaries the HIPAA privacy notices employees receive from your health plan, pharmacy, hospitals, etc. Because HIPAA notices are written at about a 3rd year college reading level, Minnesota employees/patients now have three documents--totaling 6,500 words--that "explain" their rights as a patient in Minnesota. But they're all written in language that lawyers and legislators can understand--but not employees or patients.

What rights do patients have if they can't understand those rights? And what's the point of giving patients information they can't understand? Of course, by simply distributing these documents--as required by the Minnesota legislature--health care facilities can claim that they're in compliance with state law. And they are. But why do state legislatures require incomprehensible language? Does this make any sense at all?

Compliance or communication?

Unfortunately, much health information is written in legalese that is designed to protect health care organizations, not in plain language to help employees to make better health decision. If health plans, employers, hospitals/clinics and doctors are serious about getting patients to change their behaviors, the first place they should look is at the information they give to patients, and the health literacy skills patients need to understand that information.

If you want your employees to make better health care decisions, start by analyzing the health information that's given to your employees. Bring some employees together to review and analyze--perhaps by using readability software or a formal evaluation process--your company's summary plan description(s), the benefits described by your health plan(s), sample bills and explanations of benefits, materials sent to your employees by your company and their health plan, etc.

Can your employees easily read or understand all (or any) of this information? If not, develop some standards for communicating health information to employees in ways they can both understand and use. Do not assume that employees can actually use more understandable information; there are major differences between understanding information (psychological principles) and being able to act on that information (behavioral principles).

You have two choices. You can develop a plain English plan for communicating health information to your employees. Or you can give up on the idea that health information will lead to better health care decisions.

The health care system can't have it both ways: Employees can't use information they can't understand.

About the Author

Mark Hochhauser is a readability consultant in Golden Valley. He's published over 30 articles on the readability of summary plan descriptions, patient health information, informed consent forms, online health information, HMO/managed care report cards, HIPAA privacy notices, clinical trial language, and direct-to-consumer drug ads. His e-mail address is MarkH38514@aol.com.

Mark Hochhauser, Ph.D.
Readability Consultant
3344 Scott Avenue
North Golden Valley, MN 55422
Phone: (763) 521-4672
Fax: (763) 521-5069
E-mail: MarkH38514@aol.com

Copyright 2003, Mark Hochhauser, Ph.D.