Complexity versus comprehension: A content analysis of the US Medicare prescription drug plan

Abstract

To help meet the recognised need of coverage for prescription drugs in the USA, the Federal Government expanded its Medicare plan for senior citizens to cover outpatient prescription drugs. This new coverage, termed Part D and effective in 2006, encompasses a variety of approved plans from which enrollees can select providers. Given the complexity of the plan, however, the comprehensibility of government-issued documents might be expected to suffer. A 15-page excerpt of the Medicare manual for Part D was therefore assessed for writing characteristics including readability scores, syntactic structures and verb forms. This traditional analysis was supplemented by a computerised content analysis of the frequencies and usage of selected terms. This excerpt's relatively simple writing style suggested that its authors somewhat kept in mind the target audience of senior citizens, particularly those with lower levels of general and health literacy. Results of the current research indicate that readability, syntax and grammar relate to the ability of senior citizens to comprehend complex policies. Nevertheless, traditional text assessments, even when complemented by content analysis, cannot fully compensate for the operational hurdles that Medicare Part D poses in trying to disseminate this critical information to senior citizens.