Relationship Between Health Care Costs and Very Low Literacy Skills in a Medically Needy and Indigent Medicaid Population

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Abstract
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 (≤3rd-grade reading level) were $10,688/year, but only $2,891 for those with better literacy skills (≥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.
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