Abstract
Health literacy refers to the ability to obtain, process, and understand basic health information to make health decisions. The objectives of this study were to estimate the prevalence of low health literacy in an older adult population, identify characteristics associated with low HL, and describe the impact of low HL on healthcare utilization, expenditures, and satisfaction with care. Healthcare claims, membership, and a modified version of the Consumer Assessment of Health Plan Survey (CAHPS) were used for Medicare beneficiaries with AARP® Medicare Supplement Insurance plans insured by UnitedHealthcare (for New York residents, UnitedHealthcare Insurance Company of New York). Descriptive statistics and multivariate modeling were used to evaluate those with adequate versus low HL. Sixty-four percent of those surveyed responded; among these, 16.8% indicated low HL. Lower HL was predicted by male gender, older age, more comorbidities, rural residence, and lower education. Low HL was also associated with poorer outcomes including more emergency room visits, inpatient hospitalizations, fewer flu vaccines, reduced satisfaction with providers, health plans, and overall health care, and lower compliance with evidence-based measures (EBMs). Those with low HL incurred $3,892 more in annual health expenditures than those demonstrating adequate HL. Low HL is common among older adults, increases healthcare utilization and expenditures, and negatively impacts satisfaction and compliance with EBMs.