The impact of health literacy on patient choice

Jo Ellins Picker Institute

The problems of the patient choice agenda
Health literacy and the widening of inequalities through patient choice

What needs to be done?

The problems of patient choice
Market-based choice inevitably creates winners and losers
Patients want choice, but not of the type they are being offered
There will be a net reduction in choice if wards/departments are forced to close
If health literacy isn’t tackled, choice will widen health inequalities

What is health literacy?

A range of skills needed to access, understand and act upon health information
Skills include:
health knowledge
verbal and written communication skills
ability to analyse and evaluate health information
Not just basic skills in a health context

Who is affected?

Estimated that nearly half the American adult population (90 million) have low health literacy

Disproportionately affects:

• economically disadvantaged
• ethnic minorities
• elderly
• learning disabled
• long-term ill

Using information to make choices

Both the choices patients face and the information needed to make them are highly complex
Informed choice will effectively be restricted to those with sufficient health literacy
The best quality healthcare will go to people least in need of it

South Birmingham PCT ‘Choosing your hospital’

The American experience

Greene and colleagues examined older people’s ability to choose between competing health plans
Health literacy directly associated with:
people’s confidence to make decisions about their care
and their ability to use comparative information to do so effectively

What needs to be done?

Building health literacy should be made a public health priority
A significant improvement in the accessibility and usability of patient information to support choice
Create a coherent support and advocacy framework – eg patient care advisors
Give patients choices that are meaningful to them

last updated 5/03/06