HCS 490 Week 1 Challenges Facing Consumers Example

The Paperwork Between the Patient and the Care: Administrative Burden, Health Literacy and Cost as the Challenges Facing One Family of Health Care Consumers

[Student Name]

University of Phoenix

HCS/490: Health Care Consumer - Trends and Marketing

Week 1 Assignment

[Instructor Name]

[Date]

The family and its experiences are composites written for a model paper; research findings come from the sources listed.

In the spring, a composite family of four in a mid-sized city had an ordinary three months of health care. The father's new prescription was denied at the pharmacy until his physician submitted a form. The mother received a $640 bill for a specialist visit she thought was covered. Their teenage daughter's knee MRI was delayed two weeks waiting for prior authorization. And the father's question about a lab result sat unanswered in the patient portal for five days. None of this involved a medical emergency. All of it involved the paperwork, cost and confusing language that stand between health care consumers and their care. This paper examines three challenges the family faced and what organizations can do about them.

Challenge 1: Administrative Burden

Much of the family's frustration came from tasks health care now expects patients to do themselves: finding an in-network specialist, confirming coverage, requesting prior authorization, correcting bills and following up on referrals. Kyle and Frakt (2021) measured this burden with a national survey of adults in 2019. Seventy-three percent of respondents had done at least one such task over the previous twelve months; roughly a third of that group, or 24.4% of all respondents, reported delaying or forgoing care because of one. People with disabilities were the most likely both to perform tasks and to report burden. Administrative work, in other words, is not a minor annoyance but a barrier that keeps roughly a quarter of adults from getting care when they intended to.

The family's experience fits. The mother, who managed most of the household's health care, spent an estimated 12 hours in three months on calls and forms. Two tasks, the prescription and the MRI, delayed care directly.

Challenge 2: Limited Health Literacy

Health literacy describes how well a person can locate health information, make sense of it and act on it. National literacy testing of adults in 2003 placed about a third of adults at basic or below-basic health literacy and only about one in eight at the proficient level (Kutner et al., 2006). An explanation of benefits letter, which tells patients what an insurer paid and what they owe, is written for the proficient minority. The mother, who holds a college degree, could not tell from the letter why the specialist visit was not covered; the answer, buried in a code, was that the specialist was out of network at a clinic that was otherwise in network.

Limited health literacy affects more than bills. Consumers must compare plans, understand deductibles and coinsurance, read discharge instructions and find their way around portals. Older adults, people with less education and people who speak languages other than English are most affected, yet these are often the people with the greatest health needs.

Challenge 3: Cost and Cost Sharing

The family's employer plan has a $3,000 family deductible. Until it is met, the family pays full negotiated prices for most care other than preventive services. The $640 bill and the MRI both fell within the deductible, and the family considered skipping the MRI until the daughter's knee buckled at school. Cost sharing is designed to make consumers weigh the value of care, but consumers often lack the information to judge value, and some cut back on care they need. Cost also compounds the other challenges: every billing error or coverage dispute becomes a financial question as well as an administrative one.

A Fourth Pressure: Technology as a Gate

Many of the family's tasks now happen online, through portals, insurer websites and scheduling apps. Digital tools help consumers who are comfortable with them, but they can become a gate for those who are not. The father's unanswered portal message shows a quieter problem: when an organization moves communication online without staffing it, consumers lose the phone call that used to get an answer. Organizations that offer digital tools should keep a human route open and measure how quickly online messages are answered.

Who Is Hit Hardest

The three challenges fall unevenly. Kyle and Frakt (2021) found that people with disabilities carried the heaviest administrative burden. Health literacy barriers are greatest among older adults and people with limited English. Cost barriers are greatest for families with lower incomes and high-deductible plans. A family facing all three, such as an older, low-income patient with a chronic illness and limited English, may give up on care altogether.

What Organizations Can Do

Organizations create much of the burden and can remove some of it. Four steps would have helped this family. Financial navigators could check coverage and network status before visits and explain costs in plain terms. Plain-language bills and statements, tested with patients, would show what was charged, what insurance paid and why the patient owes the balance. A single point of contact for each patient, such as a care coordinator for families with complex needs, would stop the handoffs that lose portal messages. And staff could start prior authorization as soon as a test is ordered, rather than waiting for a patient to discover the delay.

Measuring Whether It Helps

An organization can track the share of scheduled services delayed by authorization, the time to answer portal messages, the number of billing complaints and patients' ratings of how easy it is to get care. Asking patients directly how many hours they spent on paperwork would show whether the burden is shrinking.

Why This Matters for Health Administration

The course describes patients as consumers, but consumers can only act as informed buyers if the system gives them usable information and manageable tasks. Health administrators design the processes consumers must work through, from registration to billing, which places the solutions to many consumer challenges in administrators' hands, especially in a system as fragmented as the American one (Shi & Singh, 2022).

Conclusion

One family's routine three months exposed three challenges: administrative burden, limited health literacy and cost. National data show that each is widespread and that together they keep many people from care. Organizations that simplify tasks, speak plainly about costs and coordinate care can remove some of the barriers they created.

References

Kutner, M., Greenberg, E., Jin, Y., & Paulsen, C. (2006). The health literacy of America's adults: Results from the 2003 National Assessment of Adult Literacy (NCES 2006-483). U.S. Department of Education, National Center for Education Statistics. https://nces.ed.gov/pubs2006/2006483.pdf

Kyle, M. A., & Frakt, A. B. (2021). Patient administrative burden in the US health care system. Health Services Research, 56(5), 755-765. https://doi.org/10.1111/1475-6773.13861

Shi, L., & Singh, D. A. (2022). Delivering health care in America: A systems approach (8th ed.). Jones & Bartlett Learning.