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

PURPOSE: To examine the impact of low health literacy on medical care use and costs. METHODS: The study sample consisted of 3260 non institutionalized 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 ($155 1; 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. (c) 2005 Elsevier Inc. All rights reserved.