Healthcare cost literacy in the united states: Cross-sectional estimates from a representative national sample

BACKGROUND: As healthcare costs and patient cost-sharing continue to rise in the United States, little is known about patients' understanding of healthcare pricing, insurance-related expenses, and cost-planning strategies. OBJECTIVE: To assess healthcare cost literacy (HCL) among U.S. adults and identify domains in which patients report the greatest and least confidence in understanding healthcare costs. METHODS: A total of 2,308 American adults were surveyed. A cross-sectional design was utilized, incorporating a 12-item survey that examined key dimensions of healthcare cost literacy (HCL), such as healthcare cost knowledge, health insurance cost knowledge, and proactive cost planning behaviors. RESULTS: Participants reported knowing most about pharmacy-level price differences for prescription drugs (77%) and how to contest a hospital bill (56%); they reported knowing least about hospital chargemasters (33%). When asked to describe various healthcare terms, participants found it easiest to describe "deductible" (mean 2.85 [SD 0.83]) and hardest to describe "health insurance formulary" (mean 2.10 [SD 0.96]). Regarding preemptive cost planning, participants had the most difficulty with knowing the cost of an emergency room visit ahead of time (mean 2.19 [SD 0.98]) and found it easiest to know the out-of-pocket cost of a prescription drug ahead of time (mean 2.60 [SD 0.87]). Participants with high-HCL, defined as those with>median HCL score of 2.42, were more likely to be older, have greater health literacy, and be more confident in managing their healthcare (all p < .001). They were more likely to have visited a doctor in the last year and were more knowledgeable about cancer screening guidelines (both p < 0.001). CONCLUSION: Levels of HCL are varied among the adult population, with wide knowledge gaps in understanding hospital bills and insurance-related costs. Efforts to bolster levels of HCL may help patients' ability to anticipate, manage, and navigate healthcare expenses.