Relationship between health care costs and very low literacy skills in a medically needy and indigent Medicaid population

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 (less than or equal to3rd-grade reading level) were $10,688/year, but only $2,891 for those with better literacy skills (greater than or equal to4th-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.