Newly Insured Americans Don’t Understand Basic Healthcare Terms

Why increasing health literacy should be a national priority

SOFIA F. GARCIA    JAN 22 2014, 9:00 AM ET

Jon Elswick/AP

An estimated 14 percent of English-speaking adults in the United States have below-basic literacy, or an inability to perform simple reading tasks. But 35 percent have only basic or below-basic health literacy. That means more than 77 million people have difficulty with common health-related reading tasks.

Health literacy involves the ability to obtain, process, and understand the health information necessary to make appropriate decisions, and it’s clearly essential to selecting health insurance. More Americans are enrolling in federal and state-based marketplaces, but being insured is only the beginning when it comes to reducing health disparities related to literacy.

Low health literacy disproportionately affects vulnerable populations that include individuals now eligible for new health insurance options: those with lower socioeconomic status and education, or disabilities; non-white racial and ethnic groups; the elderly.

The United States’ below-average literacy among developed countries is more of a dirty, not-so-little secret.

chart showing health literacy rates in U.S.Many of these Americans are now contending with unfamiliar insurance terms and are at risk of making uninformed choices that they may regret. This matters because those with low health literacy already tend to experience poorer health and to generate increased costs, estimated by some to amount to more than $100 billion annually.

While I am not an expert on the Affordable Care Act, as a clinical psychologist who conducts research on patient-centered care and health literacy, I am concerned about how millions will find their way through the maze of information without the basic understanding they need to make good choices.

On the website, some of the communication tools used are commonly recommended by those of us working in the field of health literacy. There are videos on how to use the Marketplace and other videos portraying personal stories about selecting health insurance. Some have gotten hundreds of thousands of views so far.

Perhaps most important for those whose low literacy precludes effectively navigating a website, or for those whose primary language is something other than English or Spanish, there is the 24/7 telephone helpline as well as lists of local organizations that can provide personal assistance with applications (there are more than 500 in my area). And recently a tip sheet was released to help those with new insurance.


SOFIA F. GARCIA is an assistant professor of medical social sciences, psychiatry, and behavioral sciences at Northwestern University’s Feinberg School of Medicine.

Industry’s First Safe Driving Enforcement Solution for Apple® iOS

FleetSafer app for iOSVANCOUVER, CANADA, October 11, 2013 – Aegis Mobility, the global leader in solutions to prevent distracted driving, announced today that it has created the industry’s first safe driving solution for the Apple® iOS operating system that provides policy enforcement.

Apple’s iOS operating system presents unique characteristics for enterprise applications. It is well understood and accepted that such characteristics have, up until now, presented challenges for safe driving policy enforcement.

FleetSafer, from Aegis, now provides an enforcement solution for all Apple iOS devices including the recently released iOS 7. This Software as a Service (SaaS) product provides automatic detection of driving state via a choice of trigger methods including software-only or hardware-assisted. The most novel element of the product is a patent-pending method that (a) automatically places the device in safe mode when driving is detected, (b) removes distracting functions while in safe mode and (c) prevents a driver from circumventing the safe mode while driving.

Nandini Tare, Frost & Sullivan’s lead industry analyst, said, “Aegis Mobility is the recipient of our 2013 Customer Value Leadership Award for Distracted Driving Solutions and the company’s iOS solution adds significantly to their industry leadership. iOS devices are prevalent in almost all organizations and this innovative offering from Aegis uniquely satisfies enterprise requirements for safe driving policy enforcement on iOS.”

Paul Zimmerman, CEO of Aegis Mobility, commented, “Aegis is committed to helping our customers implement the very best solutions to address distracted driving. Apple’s iOS operating system had, until now, represented an exception in the solution portfolio available from any provider. We are extremely pleased to remove that exception and offer the industry’s broadest device coverage.”

Contact Aegis today to learn more about FleetSafer for iOS or to schedule a demonstration.

about aegis mobility
Aegis Mobility is the world’s leading provider of patented software for mobile devices to prevent workplace distracted driving. Designed specifically for corporate customers, FleetSafer enables employers to proactively promote safe and legal use of mobile devices while employees are driving on the job.

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Daniel Gélinas
+1 778-373-3843

The #1 doctor in the world is Dr. Wikipedia

Zehn Jahre Mitmachlexikon WikipediaWikipedia is the leading single source of healthcare information for patients and providers, according to a report on online engagement by IMS Health. According to the study, 50% of surveyed physicians who use the internet have consulted Wikipedia for information—especially on specific conditions. That may explain another finding: That more serious, less common diseases are actually the most frequently searched for by English-speaking Wikipedia users.Top-25-health-related-Wikipedia-articles-in-2013-Millions-of-page-views_chartbuilder

While Tuberculosis isn’t rare—the Centers for Disease Control and Prevention reported 3.2 cases per 100,000 in the US in 2012, and UK agencies reported 13.9 per 100,000—it’s certainly not the most common health concern of the average English-speaking internet user. Acne, for example, was 100th in the list for the year, drawing only 1.3 million page visits—and affects 80-90% of all teenagers. The higher searches for more serious, less common ailments, the authors suggest, could be because those are the ones that patients are less likely to have first-hand knowledge of. In other words, if acne is bothering you, you’ve probably got a few friends (and, hopefully, a dermatologist) who knows what’s what. If you find yourself in need of a Tuberculosis test or experiencing symptoms of Gout, you might be a bit more lost.

By looking at trends in drug sales—both for new prescriptions, and for continuing patients—the authors of the report also found indications that people use Wikipedia to get informed about their drug and treatment regimens. But just when they decide to do their research could depend on age: Young patients—those around 39, and younger—tended to research illnesses and drugs on Wikipedia before they started a course of treatment. Patients a decade older were likely to search their treatment right around when it was prescribed. By around age 54, though, patients were looking up their prescriptions well after they were first prescribed. The authors of the report believe this may be because of family members and caregivers searching on the behalf of the elderly, once they become aware of the patient’s new treatment or side effects it may be causing. Younger patients, this data suggests, may be more likely to weigh possible treatment options based on information found online.

California’s Department of Industrial Relations Warns Businesses Of Deceptive Notices

Labor Law Poster with $275 price rageby Carrie Dingler, Research & Compliance

The California Department of Industrial Relations, (DIR) sent out an official news release warning California business owners of recent misleading notices sent to companies from “Labor Compliance Office”.

According to the DIR, “Labor Compliance Office” demands payment (a processing fee) of $275.00 for labor-related postings. The DIR has made it very clear that the “Labor Compliance Office” is not a government agency and is not affiliated with the Labor Commissioner’s office, which is also known as the Division of Labor Standards Enforcement (DLSE), a division of DIR.

We, at Compliance Poster Company (CPC), take business ethics and social responsibility seriously. We do not condone this kind of deceptive marketing. In the labor law and compliance-related industry, desperate attempts to scam businesses hurt honest ones like ourselves.

The DLSE has clear protocol when their officials investigate businesses, which NEVER includes requesting payment during an inspection. What a business can expect includes the following:

  • All investigators will identify themselves
  • Investigators will discuss employer’s rights and responsibilities during an inspection, as well as what happens during the process
  • Investigations may include interviews with the employer and/or employees
  • If citations are issued the inspector will discuss the employer’s right to an appeal

Compliance Poster Company does not participate in unethical business practices. We at CPC share businesses concerns with unethical marketing. If you receive misleading notices by mail or are contacted in person and suspect fraudulent activity click here to contact the DIR.

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I Do Not Know If I Am Really Hurt

January 6, 2014 by 

Red Cross road sign that says, "Workers' Comp Savings Ahead"As crazy as it sounds, a lot of people do not know if they are hurt. Here is the scenario: A worker tweaks their back during some sort of work activity and they do not tell anyone that day. The next day they mention something to their supervisor about flaring up their back pain. The supervisor asks if they are ok and they answer “I don’t know.”

This happens all of the time. It is always surprising as to how a person doesn’t know if they are hurt or not. It should be simple. You are either hurt or you are not, right?

Many Minor Claims Can Be Avoided With Early Medical Treatment

Of course this is wrong. If every worker in the plant made a claim when they experienced some sort of pain you would have 9,000,000 claims each month. You trust that if the worker is really hurt, that they will tell you and want to report a claim. However, much of the time, they are not sure, and do not know what to do. So they tell their supervisor, expecting to get some sort of guidance. But the guidance doesn’t come from said supervisor.

This is a great opportunity that is missed. I tell employers if this situation happens, get the employee medical treatment by calling a 24 hour injury triage nurse (or send to a clinic if triage is not set up). It is better to be safe than sorry. But most employers are stubborn in this regard, and instead of getting them medical attention they say “Well let me know if you are hurt and we can address it at that point.”

What happens is the worker doesn’t go back to said supervisor. Because in their mind, they did go to the supervisor and told them they are hurt, and it got them nowhere. Now they work through the pain until they make it so bad they can no longer work at all. Then they want to report a claim and want to go get medical treatment. The only problem is now it is a month later.

When the adjuster gets this claim, they see the injury date as being a month ago and all sorts of red flags go up. Why wasn’t this person sent to the clinic a month ago? What happened between a month ago and now that they want to go get treatment? Why was this not reported a month ago like it should have been?

The answer is simple: The employer doesn’t want to get dinged for another possible injury on their loss run (many claims are avoided by using Injury Triage). It makes them look bad, and they worry about increased premiums and underwriting and OSHA recordings and so on.

This problem is all over the place in work comp like an epidemic. I tell employers all the time if someone comes to you and says they might be hurt, you should get them medical attention (ideally with Injury Triage) right away, because a simple back strain if caught early is super cheap to get rid of. If you wait until a month later and the guy can barely stand up straight, this is going to be a claim that is around for at least a few months, if not longer. Plus the cost is probably 4 times more now than had you sent the worker for treatment a month ago. You are shooting yourself in the foot by waiting.

If Someone Says They Might Be Hurt, They Probably Are Hurt

Continue reading I Do Not Know If I Am Really Hurt

Thoughts on the New Blood Pressure Guidelines

If your New Year’s Resolutions include lowering your blood pressure you should review this discussion about the recently released new guidelines.


New blood pressure guidelines for 2014 chart
Over 60s Can Have Slightly Higher Blood Pressure

The new blood pressure (BP) guideline, released recently in JAMA, has simplified blood pressure management and likely decreased both the number of patients needing treatment and the number of medications they need. Many commentaries have begun to flood the Internet, so of course I must add my thoughts.

First, please read Harlan Krumholz thoughts: 3 Things to Know About the New Blood Pressure Guidelines.

Here are my main thoughts:

1. This guideline panel commissioned evidence reviews — and as one of the editorials states, this gives us more confidence in the guideline. Somewhat amazingly, most of the guideline does not have a strong evidence base. The authors show great honesty in their assessment of the evidence quality. Few of these recommendations should become performance measures. Current BP performance measures encourage overtreatment.

2. The best data exist for increasing the goal BP for 60 and older to 150/90. How many patients older than 60 currently take medications to lower their BP of 140-149 to reach a goal < 140? We have significant overuse of antihypertensives in that population.

3. The guideline supports any of 4 classes for initial treatment: thiazides, ACE-I, calcium channel blockers (CCBs) or ARBs. Clearly the data do not support beta blockers as a standard treatment. I am disappointed that they do not discuss the differences in thiazides (I strongly prefer chlorthalidone to hydrochlorothiaze) nor do they comment on the differences among CCBs.

4. They do make distinctions in first line therapy for black patients. At least one critic that I read pointed out that racial distinctions are hazardous at best.

5. This guideline differs greatly from previous guidelines. The committee has, in my opinion, carefully absorbed the many opinion pieces about guidelines and the IOM recommendations.

We really do not have adequate data to answer many questions about hypertension. I like the simpler recommendations that clearly should decrease overprescribing.

Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.

Older Workers Less Likely To Have Severe Work Injuries …

… But Miss More Work Days To Recover

By 2 hours 26 minutes ago

photo of older workersWashington, DC ( – The rate of nonfatal occupational injuries and illnesses requiring days away from work to recuperate was 112 cases per 10,000 full-time workers in 2012, down from 117 cases in 2011. The median days away from work—a key measure of severity of injuries and illnesses—was 9 days in 2012. Workers age 65 and older had the lowest incidence rate in 2012 at 89 cases per 10,000 full-time workers, but they required the longest time away from work to recover, a median of 14 days.

The rates of nonfatal injury and illness cases declined in 2012 for workers age 35 and over and remained statistically unchanged for workers age 34 or younger. The incidence rates in 2012 for workers ages 16 to 19, 20 to 24, and 25 to 34 were near the overall incidence rate for all workers. Younger workers who experienced workplace injuries or illnesses typically required fewer days away from work to recover than workers in older age groups.

Workers ages 45 to 54 had the most cases of injuries and illnesses of any age group, with 293,700 cases in 2012. They also had the highest incidence rate, 121.7 cases per 10,000 full-time workers. Their median days away from work to recover was 11 days.

These data are from the BLS Injuries, Illnesses, and Fatalities program. To learn more, see “Nonfatal Occupational Injuries and Illnesses Requiring Days away from Work, 2012” (HTML) (PDF), news release USDL‑13‑2257. The scope of the survey includes private industry and state and local government but excludes the self-employed, private households, the federal government, and the United States Postal Service.

Source: Bureau of Labor Statistics, U.S. Department of Labor, The Editor’s Desk, Older workers less likely to have severe work injuries, but they miss more work days to recover on the Internet at .