Balancing Health Literacy and Healthcare Expenditures: Evidence from a Social Security Fund

Document Type : Original Article

Authors

1 Student Research Community, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

2 Social Determinants of Health Research Center, Social Health Research Institute, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

3 Department of Social Welfare Management, School of Social Health, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

Abstract

Background and Objectives: Health literacy is a crucial determinant of health outcomes and healthcare expenditures. Although health literacy is generally viewed as beneficial, its impact on healthcare expenditures, remains complex. This study aimed to 1) assess the status of health literacy and healthcare expenditures among members of a social security fund, 2) examine differences across various sociodemographic groups, and 3) explore the effect of health literacy on healthcare expenditures.

Materials and Methods: Data were collected from members of a social security fund through a health literacy questionnaire in 2022. Participants provided their insurance identification numbers, which were used to retrieve actual healthcare expenditure data from the social security fund's administrative database. This allowed for the linkage of self-reported health literacy data with corresponding expenditure records. Statistical analyses were conducted using parametric and non-parametric correlation tests, ANOVA, Kruskal-Wallis and quantile regression analysis.

Results: The mean and median of health expenditure in the sample was 703 thousand Rials  and 257.4 million IRR (equal to 143.3 and 525.3 US$, respectively), with the highest expenditures among individuals with limited disability and those self-assessing their health as poor. Health literacy scores averaged 71.7 (SD±15.1), with higher scores among women, singles, and those with higher education. A quantile regression revealed that self-rated health consistently predicted lower costs, while health literacy was linked to higher spending at median and upper quantiles. Unemployment and student status were associated with significantly reduced costs, especially among higher spenders.

Conclusion: This study underscores the complex relationship between health literacy and healthcare spending. Enhancing health literacy, while beneficial, should be accompanied by strategies to mitigate cost increases, particularly for vulnerable groups such as individuals with mild disabilities. Promoting realistic health perceptions and tailored interventions can optimize healthcare utilization, reduce unnecessary expenses, and ensure the effective allocation of resources within social security systems.

Keywords

Acknowledgements: The authors gratefully acknowledge the support of the institution that provided access to the data used in this study. Due to confidentiality agreements, the name of the institution cannot be disclosed.


Availability of data and materials: The data supporting the study's findings are available from the corresponding author upon reasonable request.


Conflicts of interest: The authors declarer no conflicts of interests.


Consent for publication: Not applicable. 


Ethics approval and consent to participate: All procedures performed in studies involving human participants were in accordance with the ethical standards of the Committee of Ethics in Research in the University of Social Welfare and Rehabilitation Sciences and approved by ethical code: IR.USWR.REC.1401.162. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki.


Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.


Author contributions: MB and SHMK contributed to the study design. SSY was responsible for data collection and literature review. Data analysis and drafting of the manuscript were performed by MB; while SHMK and SSY critically reviewed the manuscript. All authors read and approved the final version of the manuscript.


Declaration: The authors used ChatGPT, to assist with the English translation of the manuscript. The final text was thoroughly reviewed and edited by the authors to ensure accuracy, clarity, and alignment with the original intent.

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

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