The impact of low health literacy on the medical costs of Medicare managed care enrollees

doi:10.1016/j.amjmed.2005.01.010

The American Journal of Medicine

Volume 118, Issue 4, April 2005, Pages 371-377

https://doi.org/10.1016/j.amjmed.2005.01.010 Get rights and content

Abstract

Purpose

To examine the impact of low health literacy on medical care use and costs.

Methods

The study sample consisted of 3260 noninstitutionalized elderly persons enrolling in a Medicare managed care plan in 1997 in Cleveland, Ohio; Houston, Texas; South Florida; and Tampa, Florida. Health literacy—the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions—was measured using the Short Test of Functional Health Literacy in Adults. We used a 2-part regression model to examine the association between health literacy and medical costs, adjusting for age, sex, race/ethnicity, education, income, alcohol and tobacco consumption, and comorbid conditions. Results are presented as mean differences (with 95% confidence intervals [CI]) between the inadequate and adequate groups and, separately, the marginal and adequate groups.

Results

When compared to those with adequate health literacy, emergency room costs were significantly higher ($108; 95% CI: $62 to $154; P <0.0001) among those with inadequate health literacy, while differences in total ($1551; 95% CI: −$166 to $3267; P = 0.08) and inpatient ($1543; 95% CI: −$89 to $3175; P = 0.06) costs were marginally significant. Total costs were higher in the marginal health literacy group, but the difference was not significant ($596; 95% CI: −$1437 to $2630; P = 0.57).

Conclusions

Persons with inadequate health literacy incur higher medical costs and use an inefficient mix of services.

Section snippets

Study sample

Enrollment of study participants and data collection, which were conducted by the Prudential Center for Healthcare Research (now the Emory Center on Health Outcomes and Quality), have been described in detail previously.⁹ Individuals newly enrolling in the Medicare managed care plans of Prudential Healthcare in 4 locations (Cleveland, Ohio; Houston, Texas; South Florida, and Tampa, Florida) between December 1996 and August 1997 were eligible to participate. New members were contacted 3 months

Results

Among the 3260 responders, there were 800 persons with inadequate health literacy, 366 with marginal health literacy, and 2094 with adequate health literacy. There were large and statistically significant differences by health literacy level in terms of age, race/ethnicity, income, education, alcohol and tobacco consumption, and comorbid conditions (Table 1). Taken together, these comparisons show that controlling for underlying differences in individual characteristics is important when

Discussion

Recently released reports by the Institute of Medicine and Agency for Healthcare Research and Quality conclude that the 90 million adults in our country with limited health literacy cannot fully benefit from medical care and the health care system.4, 27 The reports note various interventions that hold promise for improving health literacy in various clinical settings. These include educational tools designed specifically for patients with low health literacy, health education programs for

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: This work was supported by an unrestricted grant from Pfizer.

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Clinical research studyThe impact of low health literacy on the medical costs of Medicare managed care enrollees

Abstract

Purpose

Methods

Results

Conclusions

Section snippets

Study sample

Results

Discussion

Healthy People 2010Understanding and Improving Health

Health literacyreport of the council on scientific affairs

JAMA

Priority Areas for National ActionTransforming Healthcare Quality

Health LiteracyA Prescription to End Confusion

Health literacya policy challenge for advancing high-quality health care

Health Aff.

The Twin Challenges of Mediocrity and Inequality. Literacy in the U.S. from an International Perspective

Inadequate functional health literacy among patients at two public hospitals

JAMA

Health literacy among Medicare enrollees in a managed care organization

JAMA

The association of health literacy with cervical cancer prevention knowledge and health behaviors in a multiethnic cohort of women

Am J Obstet Gynecol

Health literacy and preventive health care use among Medicare enrollees in a managed care organization

Med Care

Health literacya review

Pharmacotherapy

Functional health literacy and the risk of hospital admission among Medicare managed care enrollees

Am J Public Health

Clinical research study
The impact of low health literacy on the medical costs of Medicare managed care enrollees