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.