Health Literacy and Its Impact on Health Care Services Utilization Among Korean Older Adults

Background and Purpose: Health literacy is directly linked to older adults’ use of health care services, such as increased use of preventive health care, and lower hospitalization and emergency room use. Despite a substantial body of literature on this topic among older adults in the U.S., little is known about the link among Korean older adults. We aim to understand the link through this study.

 Methods: We used a cross-sectional survey guided by Andersen’s Health Behavior Model, and recruited a sample of 640 community-dwelling Korean adults aged 65+ living in metropolitan, suburban, and rural areas. Anderson’s model explains people’s health service utilization as contingent upon three major factors: predisposing, enabling, and need factors. The dependent variable - health care service utilization- was measured by three types of health care use:  annual check-up, outpatient clinic visits, and hospitalization. The independent variable – Health literacy- was measure using a culturally-modified version of the Test of Functional Health Literacy in Adults (TOFHLA). We used ANOVA, t-test, and correlational analyses to explore the relationships between different factors and health service utilization. We also used multivariate analyses, hierarchical regression, to investigate the relationship between health literacy and health service utilization after controlling for confounders. To perform these analyses, we used SPSS 20.0 using 0.05 as criteria for statistical significance.

Results: The current study found that older adults with a higher level of heath literacy used health care services significantly less frequently than those with lower health literacy. For each of the factors: predisposing factors: none of these factors (gender, age, or location) were significant in predicting health services utilization; enabling factors: income (β= -0.107, p<0.018) and health literacy (β = -0.122, p<0.007) were found to be negatively associated with utilization; for need factors: self-rated health status was found to be negatively associated (β = -0.323, p<0.00), but number of chronic diseases (β=0.178, p<0.00) was found to be positively associated with health service utilization.. Controlling for both predisposing and need factors, health literacy (β = -0.084, p<0.04) still remained a significant predictor.

Conclusions and Implications: This study adds to the body of research that suggests that improving health literacy can reduce the cost of health care by lowering the use of costly health services. Enhancing health literacy among Korean older adults will promote better health outcomes and help lower health care cost by both increasing timely and appropriate use of health care and lowering use of costly urgent services. Low health literacy appears to be a strong health care cost driver through higher usage of costly services or lower use of preventive services. Though more extensive research is necessary to determine why the participants with low health literacy use more health services, we contend that it is because of inappropriate or inadequate use of services. We recommend that public education to increase health literacy among Korean older adults may be one significant strategy to lower national health care costs.