Influence on Access and Use of the Health Care System Abstract

Karen Seccombe, Richard S. Lockwood and Stephen Reder



The striking number of persons with low levels of literacy in the United States is a major public-health concern.  This study examines the relationship between literacy levels and both (1) access to health care and (2) use of specific health care services among adults.  The data collected from in-person interviews with a representative sample of adults aged 18-44 in Portland, Oregon, who are proficient English speakers, and have not completed high school nor have a GED.  Adults with lower levels of literacy are less likely to have a usual provider, to have health insurance, and they have trouble understanding written medical directions, more difficulty getting needed care, and poorer health.  They also use physician services, overnight hospital stays, and emergency rooms more frequently, controlling for education, access, health, and sociodemographic characteristics.  Literacy is conceptually distinct from education and independently affects the way in which adults seek health care.