Illiteracy among Medicaid Recipients and its Relationship to Health Care Costs

Abstract

Poor literacy is associated with poor health status, but whether illiteracy is also linked to higher medical care costs is unclear. We characterized the literacy skills of 402 randomly selected adult Medicaid enrollees to determine if there was an association between literacy skills and health care costs. Each subject's literacy skills were measured with a bilingual (English/ Spanish) reading-assessment instrument. We also reviewed each subject's health care costs over the same one-year period. The mean reading level of this Medicaid population was at grade 5.6. Mean annual health care costs were $4,574 per person. There was no significant relationship between literacy and health care costs. While there are compelling reasons to improve poor reading skills among Medicaid enrollees, illiteracy in this population does not appear to contribute to the high cost of providing government-sponsored care.

Relationship Between Health Care Costs and Very Low Literacy Skills in a Medically Needy and Indigent Medicaid Population

“…First, prior studies indicated that health knowledge and health status indicators are particularly poor for subjects with reading skills at or below the 2nd-or 3rd-grade level. [2][3][4][5][6][7]9 Second, the most widely used health literacy assessment instruments categorizes subjects as being in the lowest level of literacy if reading skills are Յ3rd-grade level.…”

“…6 One might hypothesize, therefore, that limited literacy is also associated with higher health care costs. However, Weiss et al 7 found no relationship between literacy and health care costs in a study of Medicaid enrollees in Arizona. Unfortunately, although that study involved over 400 patients, most were enrolled in Medicaid because of pregnancy (which made them eligible for Medicaid benefits).…”

Assessing Readability of Patient Education Materials: Current Role in Orthopaedics

“…Poor health literacy is estimated to contribute more than 73 billion dollars of additional burden to the US healthcare system [19,51]. The healthcare cost of Medicaid patients with limited literacy is about four times that of those who have adequate health literacy [52]. Poor communication between physician and patients predisposes to medical malpractice cases, while effective communication lowers patient's anxiety, improves compliance and clinical outcome [51].…”

“…Readability, an important attribute of written material, can affect the reader's ability to comprehend. Several healthcare agencies have recommended readability of patient education materials should not be higher than sixth-to eighth-grade level [11,44,52]. However, most of the available patient education materials in orthopaedics are written at a reading level that does not meet these standards and may be too complex for comprehension by a substantial proportion of the population [4,47,48,50].…”

Health literacy and the risk of hospital admission

“…28 Weiss and coworkers found no relation between literacy and medical care costs for a random sample of Medicaid recipients in Arizona. 29 However, the patient population included too few patients in poor health at baseline to have adequate power to detect clinically important differences in health care use. We have reported previously that patients with inadequate literacy were more likely to say they had been hospitalized in the previous year, even after adjustment for age, self-reported health, and socioeconomic markers.…”