title: The impact of low health literacy on the medical costs of Medicare managed care enrollees.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Health Policy and Management, Emory Center on Health Outcomes and Quality, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA. dhhowar@emory.edu
authors.forename: David H
authors.initials: DH
authors.lastname: Howard
authors.forename: Julie
authors.initials: J
authors.lastname: Gazmararian
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Parker
mesh_terms: D000368:Aged; D004522:Educational Status; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000191:economics*; D006278:Medicare / Q000191:economics*; D008962:Models, Theoretical; D012680:Sensitivity and Specificity; D014481:United States