Outside the Clinician–Patient Relationship: A Call to Action for Health Literacy

Barry D. Weiss, M.D.

Many governmental, corporate, and nonprofit businesses, organizations, and agencies have, or should have, an interest in the health literacy problem—because limited health literacy is prevalent in the groups for which these entities are responsible. These entities can be broadly categorized as insurers, employers, and advocacy groups.

Insurers should have an interest in the health literacy problem because they pay for the medical care provided to individuals with limited literacy skills, and these individuals have higher illness rates and higher health-care costs than the population in general. Employers should care about literacy because they pay for the health insurance of their workers who have limited literacy skills, and they also lose worker productivity as a result of their employee’s limited literacy. Advocacy groups should care about the literacy problem because limited literacy skills often prevent their constituents from achieving full potential in society. Methods by which these and other organizations and systems might help improve America’s health literacy issue are shown in Table B-5, below.


Several entities provide medical insurance coverage groups in which low literacy is most prevalent. They include the publicly funded Medicare and Medicaid programs and the military’s Tricare program.


The Medicare program is a federally funded program that provides health insurance benefits to most elderly U.S. citizens. Medicare’s costs are heavily influenced by limited health literacy because of the high rate of limited literacy skills among elderly individuals. According to the Centers for Medicare and Medicaid Services, around 35 million persons over 65 years old currently receive Medicare benefits, and the number of beneficiaries increases annually (Figure B-3).

Federal expenditures for the Medicare program now exceed $240 billion per year for medical benefits, administrative costs, and program integrity costs, representing some 20 percent of all health-care spending in the country. These costs will all increase as the number of beneficiaries continues to grow (Figure B-4) (CMS, 2002).

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