The Economic Costs of Limited Health Literacy in China: Evidence From National Health Literacy Surveillance Survey

Background: We evaluate the economic costs of limited health literacy in China using data from National Health Literacy Surveillance survey.  Methods: A sample of 6,454 adults aged 15-69 years old in Ningbo, China were selected from China’s National Health Literacy Surveillance in 2019. We use box plots to examine the distribution of out-of-pocket medical spending by level of health literacy. Estimates from two-part model (2PM) are used to assess the contribution of limited health literacy on expected individual medical costs.  Findings: Expected medical costs of inadequate health literacy is predicted to take 10% (176 yuan) of the expected medical expense of a typical individual living in Ningbo. This literacy-induced medical cost is greater among the rural, female and older groups. If the level of health literacy increases from 21% to 30% (target level by 2030), we predict the aggregate out-of-pocket medical expenditure in Ningbo will decrease by 0·9 billion yuan.  Interpretations: This paper highlights there are direct and indirect economic costs associated with limited health literacy. These results would help the policymakers to evaluate cost effectiveness of relevant programs that aim to improve residents’ health literacy. Funding Statement: This work was supported by Medical Technology Program Foundation of Zhejiang [No.2021KY334; No.2018KY680], Educational Science Planning of Zhejiang [No. 2020SCG206], and Project of Zhejiang Public Welfare Fund [No. LGF19H260010]. Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: The survey protocols, instruments, and the process for obtaining the informed consent for participants were approved by the Institutional Review Board of Ningbo Municipal CDC [March 4, 2016; Reference No. IRB201603]. All participants provided written informed consents prior to the surveys (for participants under 16 years old, their parents fill in informed consent form instead).