title: Association between health literacy and medical care costs in an integrated healthcare system: a regional population based study.
abstract: BACKGROUND
  Low health literacy is associated with higher health care utilization and costs; however, no large-scale studies have demonstrated this in the Veterans Health Administration (VHA). This research evaluated the association between veterans' health literacy and their subsequent VHA health care costs across a three-year period.
  
  
  METHODS
  This retrospective study used a Generalized Linear Model to estimate the relative association between a patient's health literacy and VHA medical costs, adjusting for covariates. Secondary data sources included electronic health records and administrative data in the VHA (e.g., Medical and DCG SAS Datasets and DSS-National Data Extracts). Health literacy assessments and identifiers were electronically retrieved from the originating health system. Demographic and cost data were retrieved from the VHA centralized databases for the corresponding patients who had VHA use in all three years.
  
  
  RESULTS
  In a study of 92,749 veterans with service utilization from 2007-2009, average per patient cost for those with inadequate and marginal health literacy was significantly higher ($31,581 [95 % CI: $30,186 - $32,975]; $23,508 [95 % CI: $22,749 - $24,268]) than adequate health literacy ($17,033 [95 % CI: $16,810 - $17,255]). Estimated three-year cost associated with veterans' with marginal and inadequate health literacy was $143 million dollars more than those with adequate health literacy.
  
  
  CONCLUSIONS
  Analyses suggest when controlling for other person-level factors within the VHA integrated healthcare system, lower health literacy is a significant independent factor associated with increased health care utilization and costs. This study confirms the association of lower health literacy with higher medical service utilization and pharmacy costs for veterans enrolled in the VHA. Confirmation of higher costs of care associated with lower health literacy suggests that interventions might be designed to remediate health literacy needs and reduce expenditures. These analyses suggest 17.2 % (inadequate & marginal) of the Veterans in this population account for almost one-quarter (24 %) of VA medical and pharmacy cost for this 3-year period. Meeting the needs of those with marginal and inadequate health literacy could produce potential economic savings of approximately 8 % of total costs for this population.
authors.affiliation: HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital, 8900 Grand Oak Circle (151R), Tampa, FL, 33637, USA. joliehaun@gmail.com.|Department of Community & Family Health, University of South Florida College of Public Health, 13201 Bruce B. Downs Blvd. (MDC 56), Tampa, FL, 33612-3805, USA. joliehaun@gmail.com.
authors.forename: Jolie N
authors.initials: JN
authors.lastname: Haun
authors.affiliation: HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital, 8900 Grand Oak Circle (151R), Tampa, FL, 33637, USA. Nitin.Patel4@va.gov.
authors.forename: Nitin R
authors.initials: NR
authors.lastname: Patel
authors.affiliation: Department of Ophthalmology and Center for Healthcare Studies and VA Center of Excellence, Northwestern University Feinberg School of Medicine, 645 N. Michigan Ave. Suite 440, Chicago, IL, 60611, USA. dustin.french@northwestern.edu.
authors.forename: Dustin D
authors.initials: DD
authors.lastname: French
authors.affiliation: HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital, 8900 Grand Oak Circle (151R), Tampa, FL, 33637, USA. Robert.Campbell3@va.gov.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Campbell
authors.affiliation: Robert J Dole VAMC, 5500 East Kellogg Ave., Wichita, KS, 67218, USA. dbradham@air.org.|American Institutes for Research, Health and Social Development Program, Health Policy and Research Group, 1000 Thomas Jefferson Street, NW, Washington, DC, 20007-3835, USA. dbradham@air.org.
authors.forename: Douglas D
authors.initials: DD
authors.lastname: Bradham
authors.affiliation: HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital, 8900 Grand Oak Circle (151R), Tampa, FL, 33637, USA. William.Lapcevic@va.gov.
authors.forename: William A
authors.initials: WA
authors.lastname: Lapcevic
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019033:Delivery of Health Care, Integrated / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D057220:Health Literacy; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs; D058014:Veterans Health