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Association between health literacy and medical care costs in an integrated healthcare system: a regional population based study.

Haun JN, Patel NR, French DD, Campbell RR, Bradham DD, Lapcevic WA - BMC Health Serv Res (2015)

Bottom Line: Estimated three-year cost associated with veterans' with marginal and inadequate health literacy was $143 million dollars more than those with adequate health literacy.Analyses suggest when controlling for other person-level factors within the VHA integrated healthcare system, lower health literacy is a significant independent factor associated with increased health care utilization and costs.Confirmation of higher costs of care associated with lower health literacy suggests that interventions might be designed to remediate health literacy needs and reduce expenditures.

View Article: PubMed Central - PubMed

Affiliation: HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital, 8900 Grand Oak Circle (151R), Tampa, FL, 33637, USA. joliehaun@gmail.com.

ABSTRACT

Background: Low health literacy is associated with higher health care utilization and costs; however, no large-scale studies have demonstrated this in the Veterans Health Administration (VHA). This research evaluated the association between veterans' health literacy and their subsequent VHA health care costs across a three-year period.

Methods: This retrospective study used a Generalized Linear Model to estimate the relative association between a patient's health literacy and VHA medical costs, adjusting for covariates. Secondary data sources included electronic health records and administrative data in the VHA (e.g., Medical and DCG SAS Datasets and DSS-National Data Extracts). Health literacy assessments and identifiers were electronically retrieved from the originating health system. Demographic and cost data were retrieved from the VHA centralized databases for the corresponding patients who had VHA use in all three years.

Results: In a study of 92,749 veterans with service utilization from 2007-2009, average per patient cost for those with inadequate and marginal health literacy was significantly higher ($31,581 [95 % CI: $30,186 - $32,975]; $23,508 [95 % CI: $22,749 - $24,268]) than adequate health literacy ($17,033 [95 % CI: $16,810 - $17,255]). Estimated three-year cost associated with veterans' with marginal and inadequate health literacy was $143 million dollars more than those with adequate health literacy.

Conclusions: Analyses suggest when controlling for other person-level factors within the VHA integrated healthcare system, lower health literacy is a significant independent factor associated with increased health care utilization and costs. This study confirms the association of lower health literacy with higher medical service utilization and pharmacy costs for veterans enrolled in the VHA. Confirmation of higher costs of care associated with lower health literacy suggests that interventions might be designed to remediate health literacy needs and reduce expenditures. These analyses suggest 17.2 % (inadequate & marginal) of the Veterans in this population account for almost one-quarter (24 %) of VA medical and pharmacy cost for this 3-year period. Meeting the needs of those with marginal and inadequate health literacy could produce potential economic savings of approximately 8 % of total costs for this population.

No MeSH data available.


Unadjusted mean and median 2007–2009 VA Medical and Pharmacy Cost by health literacy levels indicate an inverse relationship, with increased cost being associated with lower levels of health literacy. Note: A = Adequate Health Literacy; M = Marginal Health Literacy; I = Inadequate Health Literacy
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Fig1: Unadjusted mean and median 2007–2009 VA Medical and Pharmacy Cost by health literacy levels indicate an inverse relationship, with increased cost being associated with lower levels of health literacy. Note: A = Adequate Health Literacy; M = Marginal Health Literacy; I = Inadequate Health Literacy

Mentions: In Table 1, total overall 3-year costs for VA health care, including inpatient, outpatient, fee-basis, and pharmacy for the study population was $1,722,761,825. Average nominal VA medical, fee-basis and pharmacy cost per patient for the three-years were significantly higher for the lower health literacy levels compare to the adequate group; for example: $17,033 for adequate, $23,508 for marginal and $31,581 for inadequate health literacy. Average nominal cost per patient (2007–2009) for inpatient care increased significantly as health literacy level decreased from adequate, marginal to inadequate ($26,879, $34,289 and $37,878 respectively; p-value < 0.001). Furthermore, outpatient and pharmacy cost for 2007–2009 are significantly higher for veterans’ with inadequate and marginal health literacy, compared to adequate health literacy. Figure 1 shows the unadjusted mean and the median cost by year and by health literacy level. The large difference in the mean and the median values signals the cost data is highly skewed, which is typical.Fig. 1


Association between health literacy and medical care costs in an integrated healthcare system: a regional population based study.

Haun JN, Patel NR, French DD, Campbell RR, Bradham DD, Lapcevic WA - BMC Health Serv Res (2015)

Unadjusted mean and median 2007–2009 VA Medical and Pharmacy Cost by health literacy levels indicate an inverse relationship, with increased cost being associated with lower levels of health literacy. Note: A = Adequate Health Literacy; M = Marginal Health Literacy; I = Inadequate Health Literacy
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4482196&req=5

Fig1: Unadjusted mean and median 2007–2009 VA Medical and Pharmacy Cost by health literacy levels indicate an inverse relationship, with increased cost being associated with lower levels of health literacy. Note: A = Adequate Health Literacy; M = Marginal Health Literacy; I = Inadequate Health Literacy
Mentions: In Table 1, total overall 3-year costs for VA health care, including inpatient, outpatient, fee-basis, and pharmacy for the study population was $1,722,761,825. Average nominal VA medical, fee-basis and pharmacy cost per patient for the three-years were significantly higher for the lower health literacy levels compare to the adequate group; for example: $17,033 for adequate, $23,508 for marginal and $31,581 for inadequate health literacy. Average nominal cost per patient (2007–2009) for inpatient care increased significantly as health literacy level decreased from adequate, marginal to inadequate ($26,879, $34,289 and $37,878 respectively; p-value < 0.001). Furthermore, outpatient and pharmacy cost for 2007–2009 are significantly higher for veterans’ with inadequate and marginal health literacy, compared to adequate health literacy. Figure 1 shows the unadjusted mean and the median cost by year and by health literacy level. The large difference in the mean and the median values signals the cost data is highly skewed, which is typical.Fig. 1

Bottom Line: Estimated three-year cost associated with veterans' with marginal and inadequate health literacy was $143 million dollars more than those with adequate health literacy.Analyses suggest when controlling for other person-level factors within the VHA integrated healthcare system, lower health literacy is a significant independent factor associated with increased health care utilization and costs.Confirmation of higher costs of care associated with lower health literacy suggests that interventions might be designed to remediate health literacy needs and reduce expenditures.

View Article: PubMed Central - PubMed

Affiliation: HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital, 8900 Grand Oak Circle (151R), Tampa, FL, 33637, USA. joliehaun@gmail.com.

ABSTRACT

Background: Low health literacy is associated with higher health care utilization and costs; however, no large-scale studies have demonstrated this in the Veterans Health Administration (VHA). This research evaluated the association between veterans' health literacy and their subsequent VHA health care costs across a three-year period.

Methods: This retrospective study used a Generalized Linear Model to estimate the relative association between a patient's health literacy and VHA medical costs, adjusting for covariates. Secondary data sources included electronic health records and administrative data in the VHA (e.g., Medical and DCG SAS Datasets and DSS-National Data Extracts). Health literacy assessments and identifiers were electronically retrieved from the originating health system. Demographic and cost data were retrieved from the VHA centralized databases for the corresponding patients who had VHA use in all three years.

Results: In a study of 92,749 veterans with service utilization from 2007-2009, average per patient cost for those with inadequate and marginal health literacy was significantly higher ($31,581 [95 % CI: $30,186 - $32,975]; $23,508 [95 % CI: $22,749 - $24,268]) than adequate health literacy ($17,033 [95 % CI: $16,810 - $17,255]). Estimated three-year cost associated with veterans' with marginal and inadequate health literacy was $143 million dollars more than those with adequate health literacy.

Conclusions: Analyses suggest when controlling for other person-level factors within the VHA integrated healthcare system, lower health literacy is a significant independent factor associated with increased health care utilization and costs. This study confirms the association of lower health literacy with higher medical service utilization and pharmacy costs for veterans enrolled in the VHA. Confirmation of higher costs of care associated with lower health literacy suggests that interventions might be designed to remediate health literacy needs and reduce expenditures. These analyses suggest 17.2 % (inadequate & marginal) of the Veterans in this population account for almost one-quarter (24 %) of VA medical and pharmacy cost for this 3-year period. Meeting the needs of those with marginal and inadequate health literacy could produce potential economic savings of approximately 8 % of total costs for this population.

No MeSH data available.