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

Am J Med. 2005 Apr;118(4):371-7. doi: 10.1016/j.amjmed.2005.01.010.


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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Educational Status
  • Emergency Medical Services / statistics & numerical data
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Male
  • Managed Care Programs / economics*
  • Medicare / economics*
  • Models, Theoretical
  • Sensitivity and Specificity
  • United States