This fall, the enrollment period for state-based health insurance began. By the end of 2014, more than 30,000,000+ new patients may be enrolled in health plans in the United States, under provisions of the Affordable Care Act (ACA). We are concerned about the lack of patient preparedness with regard to health literacy and medical science, 2 interrelated areas.1, 2
There has been a lack of medical science courses in US K-12 public schools from as far back as anyone can remember.3This can be traced back to a destructive ripple effect emanating from the 1910 Flexner Report, which produced a much needed reorganization of medical education, its intended outcome, but had negative consequences as well.4 A half century later, the Flexner Report’s negative impacts were manifested by the disappearance of human medical science courses from US college general studies tracks. Today, the majority of US college students lack access to courses on medical science, contributing to the low level of health literacy.
Patient Preparedness for the Affordable Care Act
Health literacy was defined in the 2004 US National Academy of Sciences’ Institute of Medicine Health Literacy monograph as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”5 According to an American Medical Association report, poor health literacy is a stronger predictor of a person’s health than age, income, employment status, education level, and race.6
We have concerns with the ACA’s dependency on the health literacy and medical science components of personal preparedness. First, the level of health literacy is low by any standard.2 Second, the scopes of official health literacy definitions need broadening.5 Standards should be strengthened with greater specifics based on common disease entities, for example, cancer, cardiovascular disease, and diabetes.
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– Ronald S. Weinstein, MD, FCAP, Anna R. Graham, MD, FCAP, Kristine A. Erps, Ana Maria Lopez, MD, MPH, FACP
This article originally appeared in the December 2013 issue of The American Journal of Medicine.
