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According to the Gaston Literacy Council of Gastonia, North Carolina:

Reports show that low literacy directly costs the healthcare industry over $70 million every year.

That website does not provide a specific citation for that assertion, but does broadly reference BeginToRead.com, which asserts:

Low literary costs $73 million per year in terms of direct health care costs. A recent study by Pfizer put the cost much higher.

The site claims that a "recent study by Pfizer" supports this, but does not provide a formal citation or even indicate when or where that study was published.

DoSomething.org's 11 Facts about Literacy in America, asserts:

Reports show that the rate of low literacy in the United States directly costs the healthcare industry over $70 million every year.

That website cites "WriteExpress Corporation. 'Literacy Statistics.' Begin To Read. Accessed February 24, 2015" as a source for the above assertion. This likely is the same source cited by the Gaston Literacy Council above.

The Capital Area Adult Literacy Council mentions:

Reports show that the rate of low literacy in the United States directly costs the healthcare industry over $70 million every year.

That site simply cites the DoSomething.org page mentioned above and does not mention what particular studies indicate this.

Is there any truth in the assertion that at least $70 million dollars of health care costs is directly attributable to low literacy?

As @MichaelK mentioned, there are different definitions of literacy, so an answer could explain specifically what definition was used in the research.

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    Actually Gaston Literacy — in the "Quick Facts" section — claims "Up to $73 billion is wasted annually in unnecessary healthcare expenditures due to low health literacy". However... notice that phrasing: "low health literacy". so what are we talking about here? Are we talking about literacy as in reading & writing or are we talking about this "health literacy", which I have no idea what it is supposed to be. – MichaelK Aug 6 '18 at 15:11
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    "health literacy" is not reading & writing, it is understanding your own health, describing it to doctors, and generally navigating the healthcare system: health.gov/communication/literacy/quickguide/factsbasic.htm – Bald Bear Aug 6 '18 at 15:15
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    @RobertColumbia Well, you need to find that out then, and add that clarification to the post. How can it be a notable claim if we do not really know what the claim actually is? Also note that 73 million is a very small number. With 300+ million people in the US, 70 million USD per annum is a mere 25 cent per person. Those 73 billion however is a significant cost. – MichaelK Aug 6 '18 at 15:24
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    @RobertColumbia: and who says the low-literacy person bears the [full] cost? For all we know this could mean the pharmacist or doctor needs to spend more time with that person because the patient can't fill forms. Usually healthcare is not billed per minute, so... – Fizz Aug 6 '18 at 16:08
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    I agree that $70 million is not a credible figure. There is no way the cost could be so low. According to HDR figures, 20% of U.S. adults are functionally illiterate. Surely the healthcare cost of people taking the wrong medicine because they don't understand the instructions, can't possibly be as low as 1$/person. So what this question is effectively asking for, is evidence that the U.S. healthcare costs due to low literacy are negligible. – gerrit Aug 6 '18 at 16:45
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Ironically, it appears that this claim has been badly mangled by the claimants due to poor literacy skills!

Let's start with definitions. Here is how Health Literacy: A Review distinguishes between "literacy" and "health literacy".

Literacy is defined as the basic ability to read and speak English, whereas functional health literacy is the ability to read, understand, and act on health information. Up to 48% of English‐speaking patients do not have adequate functional health literacy.

Pfizer, who were mentioned in one of the claims, emphasize the importance of health literacy:

Low health literacy affects over 90 million people in the United States. It is a crisis of understanding medical information more than a problem of access to information.

In Overview of health literacy they claim:

A recent and rigorous systematic review of health literacy associated costs conducted by Eichler et al. identified 10 studies that addressed this issue. These studies suggested that the additional costs of limited health literacy on the health system level range from 3% to 5% of the total health care costs per year. Using estimates from the National Health Expenditure Report in 2009 would therefore equate the overall economic burden of low health literacy to around $75-125 billion dollars annually. Future research will define this more precisely.

Note: $75-125 Billion, not Million.


So, this claim has been mangled:

  • health literacy became general literacy (related, but not the same)
  • 75-125 became over 73 and then over 70.
  • billion became million.

Pfizer base their estimate on The costs of limited health literacy: a systematic review:

On the health system level, the additional costs of limited HL [Health Literacy] range from 3 to 5% of the total health care cost per year. On the patient level, the additional expenditures per year per person with limited HL compared to persons with adequate HL range from US $143 to 7,798.

To reinforcing Pfizer's estimate is about the right range, here is another estimate: Low Health Literacy: Implications for National Health Policy

The savings that could be achieved by improving health literacy – a lower bound of $106 billion and an upper bound of $238 billion – translate into enough funds to insure every one of the more than 47 million persons who lacked coverage in the United States in 2006, according to recent Census Bureau estimates.

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