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Date
Jun
06
2006

The Effect of Health Literacy on Mental Health Service Outcomes in Adult Medicaid Patients

Presenter:

Richard Smith

Authors:

Richard Smith, Christine Davis, Mary Armstrong, Louis de la Parte

Chair: Glenn Blomquist; Discussant: Mark Dickie Tue June 6, 2006 8:00-9:30 Room 313

Rationale: There is growing consensus about the importance of involving health care consumers in medical decisions, as manifested in the rise of consumer-driven insurance plans. The recently proposed reforms for Florida Medicaid represent the introduction of a more consumer-driven model to populations with low economic and social resources. Consumer involvement is a challenge for those who cannot effectively understand health information. Poor health literacy has been found to result in poor health outcomes and excess costs in the tens of billions annually. Little is known, though, about the impact of health literacy on health outcomes within more disadvantaged populations.

Objective: The objective of this study is to develop an empirical model to examine the relationship of patient mental health literacy to utilization, cost, health service quality, and quality of life among current and former Medicaid recipients of mental health services in Florida.

Data: The data for this analysis comes from two sources: 1) the 2002-03 Florida Medicaid claims data, as furnished by the Florida Mental Health Institute (FMHI), and 2) the 2003 Florida Health Services Survey (FHSS), also from FMHI. These cross-sectional data are linked, consisting of all Medicaid-eligible, non-elderly adult consumers, age 20 to 65, who responded to the 2003 FHSS.

Methodology: We specify a three-equation model of the relationship between an individual consumer and his or her mental health care provider, in which outcomes are utilization, quality of care, and quality of life (cost is an outcome derived from utilization). Following earlier theoretical approaches to the provider-patient relationship, and which have recently been extended by one of the authors, we model the relationship as a two-stage process, in which the provider determines quality in the first stage, while the patient, after observing the level of quality, determines quantity (i.e. utilization) in the second stage. In addition, the model tests for consumer “empowerment” (i.e. patient control over care and having it meet needs) as a mediating determining factor between literacy and mental health care outcomes.

We employ two methods for estimating the model. Under the assumption that consumer literacy and empowerment are unrelated, independent determinants in each equation, we use the method of ordinary least squares (OLS) to estimate the model. However, under the assumption that health literacy is mediated in its effect on utilization, quality of care, and quality of life by consumer empowerment, we use the method of two-stage least squares (2SLS) to estimate the model. With 2SLS, the measure of health literacy serves as the identifying instrument for consumer empowerment. We run a standard Hausman specification test to determine which estimating approach (OLS or 2SLS) produces consistent results.

Results: Results are pending and expected to be available by December, 2005. We will relate these results to earlier work by the presenter on the relationship between patient health knowledge and outcomes in the area of general health.

Conclusions: The results will offer initial insights on applying more consumer-driven plans to public health insurance programs intended for low-income and other disadvantaged populations.

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The American Society of Health Economists (ASHEcon) is a professional organization dedicated to promoting excellence in health economics research in the United States. ASHEcon is an affiliate of the International Health Economics Association (iHEA). ASHEcon provides a forum for emerging ideas and empirical results of health economics research.