title: Educational Resources "Over the Head" of Neurosurgical Patients: The Economic Impact of Inadequate Health Literacy.
abstract: BACKGROUND
  Health literacy is the ability with which individuals can obtain, understand, and apply basic health information. Approximately 36% of Americans have basic or below basic health literacy skills. This low health literacy is particularly prevalent in neurosurgery, a growing field of medicine with considerable complexity and a patient population commonly affected with disease-related cognitive impairment. Consequences of poor patient understanding range from increased emergency department admissions rates to reduced adherence to preoperative medication instructions. Economic implications include increasing health care expenditures, decreasing access to health care, and decreasing quality of care. Health literacy costs the United States $106-236 billion per year.
  
  
  METHODS
  Consequences of inadequate patient understanding vary widely. This article reviews and addresses the economic impact of the failure to address low health literacy in neurosurgery.
  
  
  RESULTS
  Various groups have proposed techniques and devised outlines to improve health literacy, such as detailing principles targeting the underlying issues of health care illiteracy. The government, through legislation including the Affordable Care Act and the National Action Plan to Improve Health Literacy, has also shown its desire to remedy the effects of insufficient health literacy.
  
  
  CONCLUSIONS
  Despite current efforts, further action is still needed. Health literacy is a key determinant in ensuring longevity and quality of life.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. Electronic address: agarwaln@upmc.edu.
authors.forename: Nitin
authors.initials: N
authors.lastname: Agarwal
authors.affiliation: Department of Biology, The College of New Jersey, Ewing, New Jersey, USA.
authors.forename: Kush
authors.initials: K
authors.lastname: Shah
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Jeremy G
authors.initials: JG
authors.lastname: Stone
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Christian B
authors.initials: CB
authors.lastname: Ricks
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Friedlander
mesh_terms: D006266:Health Education; D057220:Health Literacy / Q000191:economics*; D006801:Humans; D009493:Neurosurgery / Q000191:economics*; D019635:Neurosurgical Procedures / Q000191:economics*; D010343:Patient Admission / Q000706:statistics & numerical data; D058991:Patient Protection and Affordable Care Act; D014481:United States
keywords: Health care economics; Health literacy; Neurologic surgery