Health Literacy Impact on National Healthcare Utilization and Expenditure

Background Health literacy presents an enormous challenge in the delivery of effective healthcare and quality outcomes. We evaluated the impact of low health literacy (LHL) on healthcare utilization and healthcare expenditure.   Methods Database analysis used Medical Expenditure Panel Survey (MEPS) from ۲۰۰۵-۲۰۰۸ which provides nationally representative estimates of healthcare utilization and expenditure. Health literacy scores (HLSs) were calculated based on a validated, predictive model and were scored according to the National Assessment of Adult Literacy (NAAL). HLS ranged from ۰-۵۰۰. Health literacy level (HLL) and categorized in ۲ groups: Below basic or basic (HLS <۲۲۶) and above basic (HLS ≥۲۲۶). Healthcare utilization expressed as a physician, nonphysician, or emergency room (ER) visits and healthcare spending. Expenditures were adjusted to ۲۰۱۰ rates using the Consumer Price Index (CPI). A Pvalue of ۰.۰۵ or less was the criterion for statistical significance in all analyses. Multivariate regression models assessed the impact of the predicted HLLs on outpatient healthcare utilization and expenditures. All analyses were performed with SAS and STATA®۱۱.۰ statistical software.   Results The study evaluated ۲۲ ۵۹۹ samples representing ۵۰۳ ۳۷۴ ۶۴۸ weighted individuals nationally from ۲۰۰۵-۲۰۰۸. The cohort had an average age of ۴۹ years and included more females (۵۷%). Caucasian were the predominant racial ethnic group (۸۳%) and ۳۷% of the cohort were from the South region of the United States of America. The proportion of the cohort with basic or below basic health literacy was ۲۲.۴%. Annual predicted values of physician visits, nonphysician visits, and ER visits were ۶.۶, ۴.۸, and ۰.۲, respectively, for basic or below basic compared to ۴.۴, ۲.۶, and ۰.۱ for above basic. Predicted values of office and ER visits expenditures were ۱۲۸۴ and ۱۵۱, respectively, for basic or below basic and ۷۱۹ and ۱۰۰ for above basic (P < .۰۵). The extrapolated national estimates show that the annual costs for prescription alone for adults with LHL possibly associated with basic and below basic health literacy could potentially reach about ۱۷۲ billion.   Conclusion Health literacy is inversely associated with healthcare utilization and expenditure. Individuals with below basic or basic HLL have greater healthcare utilization and expendituresspending more on prescriptions compared to individuals with above basic HLL. Public health strategies promoting appropriate education among individuals with LHL may help to improve health outcomes and reduce unnecessary healthcare visits and costs.

کلیدواژه ها:

Health Literacy ، Healthcare Expenditure ، Utilization ، Prescription Expenditure