Relationship between health care costs and very low literacy skills in a medically needy and indigent Medicaid population

J Am Board Fam Pract. 2004 Jan-Feb;17(1):44-7. doi: 10.3122/jabfm.17.1.44.


Objectives: Previous research established that low literacy is independently associated with poorer health. Our objective was to determine whether low literacy skill also is associated with higher health care charges.

Methods: We studied persons enrolled in Medicaid because of medical need/indigence by testing literacy skills in English or Spanish and measuring annual health care charges. Statistical analyses determined if, after adjusting for sociodemographic variables, literacy was associated with charges.

Results: Mean charges among subjects with very low literacy skills (< or =3rd-grade reading level) were 10,688 dollars/year, but only 2,891 dollars for those with better literacy skills (> or =4th-grade reading level), statistically significant difference (P =.025). This difference persisted after adjustment for potentially confounding sociodemographic variables.

Conclusions: Based on this small study, very limited reading skills seem to be independently associated with higher health care charges among medically needy and medically indigent Medicaid patients.

MeSH terms

  • Adult
  • Aged
  • Arizona
  • Educational Status*
  • Female
  • Health Care Costs / statistics & numerical data*
  • Health Services Research
  • Health Status
  • Humans
  • Male
  • Medicaid / economics
  • Medicaid / statistics & numerical data*
  • Middle Aged
  • Poverty / economics
  • Poverty / statistics & numerical data*