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 (< or =3rd-grade reading level) were 10,688 dollars/year, but only 2,891 dollars for those with better literacy skills (> or =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.