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Health literacy or poverty: associations with Medicaid costs in southwestern Pennsylvania

Penzelik, Joseph (2018) Health literacy or poverty: associations with Medicaid costs in southwestern Pennsylvania. Master Essay, University of Pittsburgh.

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Background: Through understanding the impact of social determinants of health on health care-related costs, the potential exists to mitigate their effects and improve public health. The aim of this study was to evaluate the effects of health literacy and poverty on health care-related costs for Medicaid recipients enrolled in a managed care organization in Southwestern Pennsylvania.

Methods: Members from a managed care organization (n=93,261) were selected based on two criteria: they continuously received Medicaid benefits from April 2016 through March 2017 and they resided in Southwestern Pennsylvania, as determined by census tract. Multi-variable linear regression was used to study the relationships between poverty, health literacy, and health care-related costs (i.e. medical, pharmacy, and total health care costs) after adjusting by age, gender, comorbidities, claims related to drug-abuse, claims related to alcohol-abuse, history of suicidal ideations, and frailty related conditions. Results were presented as β coefficients and 95% confidence intervals for health literacy and poverty as they related to each type of cost.

Results: Multiple linear regression analyses showed a negative association between poverty level and health care-related costs (i.e. as level of poverty increases, health care-related costs decrease) [total health care costs, β= -275.88, 95% CI (-465.80, -85.96); medical costs, β= -171.18, 95% CI (-285.37, -57.00); pharmacy costs, β= -83.92, 95% CI (-203.05, 35.21)]. Results showed a positive association between health literacy and all health-related costs (i.e. as health literacy increases, health care-related costs increase) [total health care costs, β= -1048.24, 95% CI (-1714.16, -382.33); medical costs, β= -586.25, 95% CI (-995.93, -176.57); pharmacy costs, β= -331.25, 95% CI (-749.00, 86.50)]. Results showed no statistically significant associations between independent variables and pharmacy costs.

Conclusions: Results from this study suggest that as health literacy improves or poverty decreases, health care-related costs increase. These results are not consistent with previous studies. Future studies are needed to better understand the associations between social determinants of health and health care-related costs. The results of this study and findings from previous studies can help to better inform managed care organizations and policy makers to aid in implementing preventative measures and interventions which could improve public health.


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Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Penzelik, Josephjwp54@pitt.edujwp54
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairRosario, Beddabedda.rosario@pitt.eduUNSPECIFIEDUNSPECIFIED
Committee MemberElias, Thistleelias@pitt.eduUNSPECIFIEDUNSPECIFIED
Committee MemberRodgers, ElizabethERodgers@GatewayHealthPlan.comUNSPECIFIEDUNSPECIFIED
Date: 3 January 2018
Date Type: Completion
Number of Pages: 30
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Date Deposited: 17 Jul 2018 16:16
Last Modified: 17 Jul 2018 16:16


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