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September 24, 1997

Patients' Lack of Literacy May Contribute to Billions of Dollars in Higher Hospital Costs

JAMA. 1997;278(12):971-972. doi:10.1001/jama.1997.03550120029010

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PHYSICIANS, nurses, hospitals, pharmacists and other providers of medical care are not the only controllers of health care costs. The US educational system plays a substantial role and, according to a recent estimate, it is in such a parlous state that its results—or lack of results—contribute to an estimated $15 billion a year in excess hospital costs alone.

Some 40 million to 44 million Americans are functionally illiterate, the National Adult Literacy Survey has estimated. They are unable to read and comprehend adequately to function in society. Apart from other social disadvantages, this means they cannot understand a physician's prescription or health care instructions, and, perhaps even more important, they are unable to navigate through the complex health care system. The result is that not only are they in poorer health, with higher health care costs and more frequent hospitalizations than their literate fellow Americans, but they are unable