Health Literacy and Use of Outpatient Physician Services by Medicare Managed Care Enrollees

David W. Baker, Julie A. Gazmararian, Mark V. Williams, Tracy Scott, Ruth M. Parker, Diane Green, Junling Ren, Jennifer Peel

Research output: Contribution to journalArticlepeer-review

152 Scopus citations


OBJECTIVE: To determine whether inadequate functional health literacy adversely affects use of physician outpatient services. DESIGN: Cohort study. SETTING: Community. PARTICIPANTS: New Medicare managed care enrollees age 65 or older in 4 U.S. cities (N = 3,260). MEASUREMENTS AND MAIN RESULTS: We measured functional health literacy using the Short Test of Functional Health Literacy in Adults. Administrative data were used to determine the time to first physician visit and the total number of visits during the 12 months after enrollment. The time until first visit, the proportion without any visit, and adjusted mean visits during the year after enrollment were unrelated to health literacy in crude and multivariate analyses. Participants with inadequate and marginal health literacy were more likely to have an emergency department (ED) visit than those with adequate health literacy (30.4%, 27.6%, and 21.8%, respectively; P = .01 and P < .001, respectively). In multivariate analysis, the adjusted relative risk of having 2 or more ED visits was 1.44 (95% confidence interval, 1.01 to 2.02) for enrollees with marginal health literacy and 1.34 (1.00 to 1.79) for those with inadequate health literacy compared to participants with adequate health literacy. CONCLUSIONS: Inadequate health literacy was not independently associated with the mean number of visits or the time to a first visit. This suggests that inadequate literacy is not a major barrier to accessing outpatient health care. Nevertheless, the higher rates of ED use by persons with low literacy may be caused by real or perceived barriers to using their usual source of outpatient care.

Original languageEnglish
Pages (from-to)215-220
Number of pages6
JournalJournal of General Internal Medicine
Issue number3
StatePublished - Mar 2004

Bibliographical note

Funding Information:
The study design for this project was approved by the Institutional Review Boards at MetroHealth Medical Center, USQA Center for Health Care Research, and Emory University. Patient enrollment and data collection for this study have been described in detail previously.3 A consecutive series of new Medicare managed care enrollees in Cleveland, Houston, Tampa, and South Florida were


  • Educational status
  • Emergency medicine
  • Literacy
  • Office visits

ASJC Scopus subject areas

  • Internal Medicine


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