John A. Burns School of Medicine, University of Hawaii, Honolulu, USA.
Health Aff (Millwood). 2012 May;31(5):1039-48. doi: 10.1377/hlthaff.2011.0954.
Despite high rates of low health literacy among uninsured American adults, empirical research until now has not quantified whether low health literacy is associated with lack of health insurance above and beyond other related factors, such as employment, the availability of employment-based insurance, race or ethnicity, and poverty. This study analyzed a large, representative sample of adults in California and found that even when these related factors were considered, people with low health literacy were more likely to be uninsured than those with adequate health literacy. This finding represents the first empirical evidence that low health literacy predicts the lack of health insurance in adults. The study also found that among people who were uninsured, those with low health literacy were sicker and less likely to have ever had health insurance. They were also more likely to be eligible for the expanded Medicaid program under the Affordable Care Act, compared to uninsured respondents with adequate health literacy. These findings suggest that it will be critical to keep health literacy in mind in implementing the law--for example, in the design of eligibility documents and required forms, insurance exchange interfaces, and educational and outreach campaigns related to the Medicaid expansion and the insurance exchanges.
尽管美国未参保成年人的健康素养水平普遍较低，但截至目前，实证研究尚未量化健康素养低下是否与其他相关因素（如就业、提供就业保险、种族或族裔以及贫困）以外的因素相关，导致其没有医疗保险。本研究分析了加利福尼亚州的一个大型代表性成年人样本，发现即使考虑到这些相关因素，健康素养低下的人比健康素养足够的人更有可能没有医疗保险。这一发现代表了第一个经验证据，表明低健康素养可以预测成年人缺乏医疗保险。该研究还发现，在没有医疗保险的人群中，健康素养低下的人病情更严重，且更不可能曾经有过医疗保险。与健康素养足够的未参保受访者相比，他们更有可能有资格参加《平价医疗法案》下扩大的医疗补助计划。这些发现表明，在实施该法律时，牢记健康素养将至关重要，例如在制定资格文件和要求表格、保险交易所界面以及与医疗补助扩大和保险交易所相关的教育和外展活动时。
