The impact of low health literacy on the medical costs of Medicare managed care enrollees
The impact of low health literacy on the medical costs of Medicare managed care enrollees
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DOI：
10.1016/j.amjmed.2005.01.010
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发表时间：
2005-04-01
影响因子：
5.9
通讯作者：
Parker, RM
中科院分区：
文献类型：
--
作者：
Howard, DH;Gazmararian, J;Parker, RM
目的：探讨低健康素养对医疗服务使用和成本的影响。方法：研究样本包括1997年在俄亥俄州克利夫兰参加医疗保险管理护理计划的3260名非机构老年人；得克萨斯州休斯敦的;南佛罗里达;以及佛罗里达州的坦帕市。健康素养——个人获得、处理和理解做出适当健康决策所需的基本健康信息和服务的能力程度——是用成人功能健康素养短测试来衡量的。我们使用了一个两部分回归模型来检验健康素养与医疗费用之间的关系，调整了年龄、性别、种族/民族、教育、收入、烟酒消费和合并症。结果显示为不充分组和充分组之间的平均差异（95%置信区间[CI]），分别为边缘组和充分组。结果：与健康素养充足的患者相比，健康素养不足的患者急诊室费用显著较高（108美元；95% CI: 62美元至154美元；P < 0.0001），而总费用（155美元；95% CI: - 166美元至3267美元；P = 0.08）和住院费用（1543美元；95% CI: - 89美元至3175美元；P = 0.06）差异不显著。边际健康素养组的总成本较高，但差异不显著（596美元；95% CI: - 1437美元至2630美元；P = 0.57）。结论：卫生素养不足的人会产生更高的医疗费用，并使用效率低下的服务组合。(c) 2005爱思唯尔公司版权所有。
PURPOSE: To examine the impact of low health literacy on medical care use and costs.METHODS: The study sample consisted of 3260 non institutionalized elderly persons enrolling in a Medicare managed care plan in 1997 in Cleveland, Ohio; Houston, Texas; South Florida; and Tampa, Florida. Health literacy-the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions-was measured using the Short Test of Functional Health Literacy in Adults. We used a 2-part regression model to examine the association between health literacy and medical costs, adjusting for age, sex, race/ethnicity, education, income, alcohol and tobacco consumption, and comorbid conditions. Results are presented as mean differences (with 95% confidence intervals [CI]) between the inadequate and adequate groups and, separately, the marginal and adequate groups.RESULTS: When compared to those with adequate health literacy, emergency room costs were significantly higher ($108; 95% CI: $62 to $154; P < 0.0001) among those with inadequate health literacy, while differences in total ($155 1; 95% CI: -$166 to $3267; P = 0.08) and inpatient ($1543; 95% CI: -$89 to $3175; P = 0.06) costs were marginally significant. Total costs were higher in the marginal health literacy group, but the difference was not significant ($596; 95% CI: -$1437 to $2630; P = 0.57).CONCLUSIONS: Persons with inadequate health literacy incur higher medical costs and use an inefficient mix of services. (c) 2005 Elsevier Inc. All rights reserved.