Could you (suggest) tightly organize and focus content enclosed, into a literature review research paper incorporating appropriate economic scholarly peer reviewed journals or articles discussing demand & supply, cost effective managerial decisions ? This paper needs to be focused as it is currently going in too many directions.

Literature Review format:

Abstract, Introduction, Thesis Statement, key terms, definitions, methods, review of related literature, key (findings/ implications), references

Thesis Statement:

What Effect does Health Literacy Screening have on Healthcare Expenditure

Abstract

Chronic illness coupled with low health literacy produces healthcare overutilization. This increases the demand for healthcare and creates scarcity of services.Healthcare managers must make cost effective decisions while dealing with healthcare constraints.One constraint is low health literacy which can be effectively screened for. The results of studies on health literacy screening suggest that it can target patients with low health literacy levels for educational interventions. Such interventions can improve patient comprehension, engagement, and quality of life, thus decreasing healthcare expenditures and provider time. Therefore, increased patient health literacy screening is needed to increase patient-specific interventions that result in improved communication between patients and providers. The resulting empowerment of vulnerable patient groups is a significant step towards addressing the economic health care dilemma.

Keywords: Chronic Illnesses, Low Health Literacy, Overutilization, Demand, Inelasticity, Price ceiling, Health Literacy Screening, and labor force cost,

Introduction

The global epidemic of chronic illnesses and disparities in healthcare access and quality

exposes a large sector of the population to poor prognoses and unfavorable outcomes (Schaffler et al., 2018). One public health issue that exacerbates this crisis is low health literacy (Verney et al., 2019), which inhibits the effectiveness of patient-provider communication, patient comprehension of instructions, and patient adherence to treatment (Ownby, Acevedo, & Waldrop-Valverde, 2019). One in ten adults in the United States is considered health literate. Multiple studies indicated that low health literacy results in poor health among the aged and the socioeconomically disadvantaged. The consequences include increased hospital admissions, a lack of preventative healthcare involvement, and prescription drug use failure. These forces have contributed to increasing health care costs within the United States touching 2.7 trillion dollars in 2011 (Rasu, Bawa, Suminski, Snella, & Warady, 2015). In large part these problems come from an overuse of healthcare services by patients who fail to understand physician instructions. This in turn leads to rising health-related expenditures to increase (). Patient health literacy screenings can identify the patients who are at risk, allowing providers the opportunity to address the patient's comprehension barriers. By resolving these barriers, unnecessary health related complications can be prevented, increasing efficiency & quality and lowering provider costs (Ownby, Acevedo, & Waldrop-Valverde, 2019). Managerial economics of healthcare proposes to incorporate cost- effective decisions while setting prices and supplies of such services at an affordable level. The demand for healthcare services always out-weighs the supply. Both the prices of services and patient income levels are inelastic regarding healthcare. This makes healthcare services and resources difficult to allocate effectively. If a healthcare manager is to be effective with tackling overutilization and increasing healthcare costs, he or she must identify and address constraints such as overutilization, demand and supply, healthcare inelasticity, price ceilings, provider time use, labor force cost effectiveness and incentives (Baye, 2017).

Definitions

Chronic Illness is an irregular and continuous biological disruption that affects an individual's health. (Williams, 2000). Within the United States alone 125 million individuals have some form of chronic illness, limited functionality and or disability. These patients typically visit at least 16 physicians annually. Care for these patients must be implemented in a coordinated fashion to prevent treatment duplication (waste) (Bodenheimer, 2008).

Low Health Literacy is a lack of functional health literacy (Seurer & Vogt, 2013). The population groups at highest risk for low health literacy resemble those most at risk for health disparities in chronic diseases. These endangered populations include the aged, the economically and educationally disadvantaged, racial/ethnic minorities, and non-native English speakers (Fleary & Ettienne, 2019).

Demand and supply of healthcare discusses healthcare services and treatment as a necessary good. Therefore, demand for healthcare services will always exceed that of the supply. Individuals have different types and levels of needs and wants as it relates to goods or services. There are several forces that determine whether the need or want can be obtained. Most have to do with accessibility. However, there are some access issues regarding healthcare services, particularly in terms of the location (Tchounwou, 2004). The five A's of healthcare access are availability, accessibility, accommodation, acceptability, and affordability (Penchansky & Thomas, 1981). All of these aspects must be considered.

Inelasticity of healthcare service is described as health as being a special type of good where both price and income elasticity of healthcare services are inelastic as health is a necessary good. The change in the demand for healthcare service due to the change in price depends on various factors such as effectiveness of the services provided, premium on healthcare services, etc. Income changes also have insignificant impact on the demand pattern of individuals. A variable that is non-responsive to a change in another variable is considered inelastic. If the co-pay for health care increases the quantity demanded will remain the same. Baye, M. R. (2017).

Price Ceiling is a mechanism used by the government to set the cost of a product or service to prevent discrimination. Baye, M. R. (2017).

Health Literacy Screening is the use of a specific questionnaire or test to identify the patient's knowledge base when it comes to health instructions and adherence to treatment (Stagliano & Wallace, 2013). Several validated instruments are available and have been used in various healthcare settings to measure the patient's levels of health literacy including the Test of Functional Health Literacy in Adults (TOFHLA), the Newest Vital Sign (NVS), and the Rapid Estimate of Adult Literacy in Medicine (REALM) and the REALM-Short Form (Arozullah et al., 2007; Davis et al., 1991; Parker, Baker, Williams, & Nurss, 1995; Warring et al., 2018; Weiss et al., 2005). Patient "teach back" is a health proficiency tool used to assess patient comprehension (Centrella-Nigro & Alexander, 2017).

Cost effective Intervention

Methods

Reviewed research articles were selected from searches of various databases through Cornerstone University's Miller Library, using relevant subject and text word terms. Additional search assistance came from the key terms used including demand, inelasticity, supply, price ceiling, healthcare overutilization, provider time use, labor force cost and incentives, and low health literacy screening. Eliminating broad terms was required to focus on the research question and thesis. Articles ranged from the early mid 2000's to 2020. The selected articles revealed economic healthcare constraints, health literacy issues, and the need to implement health literacy screenings and interventions to help patients and providers improve quality of care, and labor force economics of healthcare providers. The results of these studies were examined to identify the effects on the perceptions of both patients and providers and the health outcomes for the patients with low health literacy.()

Review of Related Literature

Published articles were reviewed to identify the significance of economic constraints faced by healthcare managers, who must make cost-effective decisions. Studies include evaluations of provider time use, labor force costs, incentives and changes in research methods and interventions as related to health literacy screening and its impact on the quantity of healthcare demand.

Overutilization (find several sources involving economics)

The Affordable Care Act provided insurance to Americans who were previously uninsured, resulting in an increased demand for primary health care services. Overall, the increase in health care access must be met with a reform in the way health care services are delivered to prevent the consequences of inadequate health care (Huang & Finegold, 2013). Demand is directly influenced by the composition of the population (Baye, 2017). Widespread low health literacy and chronic illness further increases the demand for health care services in the form of emergency room services, hospital admissions, and excessive primary care visits. This is descriptive of what is considered overutilization. treatment (Ownby, Acevedo, & Waldrop-Valverde, 2019).

Demand and Supply Constraints

Healthcare demand is ever increasing among those with low health literacy. Individualseffected by LHL are the aged, minorities, socioeconomically disadvantaged and patients diagnosed with chronic illnesses.

Inelasticity

As health care costs continue to rise, the demand for healthcare remains unaffected due to its inelastic nature. If the cost of health care or copays increases by 1%, the measurable amount of demand will have less than a 1% shift. There are no substitutes for health care. Watanabe, N. M. (n.d.). Demand Elasticity and Inelasticity in Sports.

A literature review analyzed healthcare constraints in services within the delivery system served. The healthcare system was departmentalized according to the level and type of urgency, complexity of disease, bodily processes, method of delivery and population served. Because of the complexity of the subject, there were contradicting objectives and metrics in published studies. Health care supply constraints were differentiated by evaluating various health delivery difficulties that included supply constraints.Supply and demand operational modes (DSO) are the action steps used by health care systems. DSO modes could be used to comprehend active healthcare concerns and identify the difficulties that need to be addressed (prevention, emergency, one visit, project, elective cure, and care). Industrious leadership can make progress towards improvement in each of these modes. The authors conclude that managerial perception is required to distinguish and coordinate effective decisions. (Lillrank, Groop, & Malmstrm, 2010).

Supply Constraints

Providers are not always available to address every health care need or provide answers to questions presented to them by every patient even when their patient load is manageable. Paul Lillrank states "...clinical medicine cannot always produce the outcomes that patients expect. Diagnoses cannot always be made accurately, and some medical conditions have no known cure and may lead to chronic or terminal conditions" (Lillrank, Groop, & Malmstrm, 2010).

Furthermore, certain conditions cannot be treated with medical treatments, but require self-efficacy and lifestyle changes involving the patients' lifestyle. Provider-centric healthcare involves interventions that only require the patient to attend their appointment. For example, a mammogram screening only involves one visit before a diagnosis. Lifestyle changes are acted upon solely by the patient. However, a health care worker can provide valuable awareness and information to motivate and remind patients to take an active role in promoting their own health. Non-licensed health providers can provide interventions, helping patients develop an individualized plan with short-term, and long-term measurable goals and follow up. This type of intervention can prove useful in motivating individuals to participate in treatment protocols given by the provider, thus alleviating provider supply and time constraints.

Price Ceiling Constraints

Lack of supply discriminates or even prevents individuals from accessing products and services. For this reason, many individuals in need of a product or service cannot obtain it. According to the economic costs system, price determines who will receive the product or service; those that can afford the product or service are the ones who will benefit from its use. This inequity demands a logical arrangement be put in place to allow fair access to health care services (Baye, 2017).

Healthcare insurance companies regulated by the government and state are the gatekeepers. They determine the amount of healthcare coverage individuals have and how much providers can charge for health care services (price ceiling). This provides insured individuals access to treatment. However, providers cannot be manufactured, requiring that healthcare services be managed according to the supply of providers. Individual health care needs vary according to the degree of severity, necessity, and timing. Furthermore, a lack of supply will cause many individuals who have qualifiable insurance and healthcare needs to go untreated. (Lillrank, Groop, & Malmstrm, 2010).

Health literacy Screenings

Health literacy screenings identify the presence of risk factors that inhibit the effectiveness of patient-provider communication, patient comprehension of treatment instructions, and patient adherence to treatment (Ownby et al., 2019). Furthermore, research in this area focuses on how to identify low literacy and improve patient's ability to engage in a meaningful dialogue regarding diagnosis and self-care (Stagliano & Wallace, 2013). For example, one study described the installation of a hospital electronic screening system that would track patient perception regarding their experience, demographics and frequencies of hospital admissions (Sand-Jecklin et al., 2017).

Cost Effectiveness

Motivation for change stems from an examination of pay rate data:

Low, Median, and High Salaries by Staff Type

Staff Type

Low Salary

Median Salary

High Salary

MD/DO

$224,660

$253,512

$290,949

Nurse Practitioner/ Physician Assistant

$110,811

$127,251

$151,599

Registered Nurse

$66,831

$80,568

$100,916

LPN/LVN

$44,589

$51,677

$62,486

Medical Assistant

$34,893

$40,841

$48,736

Licensed Clinical Social Worker

$76,536

$83,048

$89,743

Health Coordinator

$36,919

$46,470

$59,664

(Peikes et al., 2014).

Next, the practice manager will determine the average count of visits the practice has per year. Inserting those numbers into the formula (labor force costs) / (visits per year) will result in an approximate cost per visit. Effective managers will decide who does the screening according to this calculation with the goal of reducing the cost per visit.

Team Based Healthcare

Private and public health insurance companies within the United States are experimenting to see whether the delivery ofcomprehensive primary care services should be geared toward the patient as a whole to improve patient provider experience and health outcomes, while reducing health care time and cost. Incorporating a healthcare intervention model that not only include the medical team but patient support staff, patient, and caregiver working jointly to promote self- efficacy could prevent unfavorable outcomes of disease or illnesses that are timely and costly. Expanding staff to collaborate with the team could potentially provide insight into the patient's needs. The goal is to offer patients a higher quality of healthcare services that could offset costs associated with the lack of appropriate intervention and patient adherence to treatment. Physician shortages restrict the time required to fully evaluate the needs of every patient. (Peikes et al., 2014).

Key Findings / Implications for Professionals

Practice managers can incorporate health literacy screenings into patients' health assessment utilizing a health coordinator versus the licensed practitioner and provide incentives to promote its use by the entire team. This will reduce cost and improve the communication of treatment plans to patients while simultaneously empowering patients to be engaged in managing their own care. (Sand-Jecklin et al., 2017).

We have seen by the data health literacy screenings are a cost-effective way to improve profit margins through implementing health literacy screening and therefore reducing health care over utilization. This improvement will reduce insurance company costs and improve patient perception and experience of the entire healthcare system.

References

Baye, M. R. (2017). Managerial economics and business strategy (9th ed.). NY: Irwin/McGraw-Hill.

Brown, S. M. (2007, February 15). Extending American health care. Retrieved September 22, 2020, from https://www.economist.com/letters-to-the-editor-the-inbox/2007/02/15/extending-american-health-care

Huang, E. S., & Finegold, K. (2013). Seven Million Americans Live In Areas Where Demand For Primary Care May Exceed Supply By More Than 10Percent. Health Affairs, 32(3), 614-621. doi:10.1377/hlthaff.2012.0913

Jacobs, R. J., Lou, J. Q., Ownby, R. L., & Caballero, J. (2016, June). A systematic review of eHealth interventions to improve health literacy.

Lee, K. K., Austin, J. M., & Pronovost, P. J. (2016). Developing a measure of value in health care. Value in Health, 19(4), 323-325. doi:10.1016/j.jval.2014.12.009

Lillrank, P., Groop, P. J., & Malmstrm, T. J. (2010). Demand and Supply-Based Operating Modes-A Framework for Analyzing Health Care Service Production. Milbank Quarterly, 88(4), 595-615. doi:10.1111/j.1468-0009.2010.00613.x

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