The association between health literacy and medical out-of-pocket expenses among residents in China

Aim To explore the association between health literacy and medical out-of-pocket (MOOP) expenses among Chinese residents based on the 2020 China Health Literacy Survey. Subjects and methods Non-institutionalized residents aged 15–69 years were extracted from 31 provinces in China. Health literacy was assessed using the Chinese Health Literacy Scale. Results A total of 49,967 respondents were included in this study. Compared to participants with adequate health literacy, participants with intermediate, basic, and below basic health literacy were likely to create more MOOP, the unadjusted coefficients being 224.294 ( p < 0.05), 316.676 ( p < 0.01), and 458.883 ( p < 0.01) respectively. After adjusting for demographic characteristics and socio-economic elements, health literacy was significantly associated with MOOP ( β = −4.970, SE = 2.470, p < 0.05). Of six dimensions of health literacy, five were associated with MOOP in unadjusted models ( p < 0.001 or p < 0.01). However, in adjusted models, only infectious disease literacy ( β = −52.347, SE = 17.853, p < 0.01) and medical care literacy ( β = −29.603, SE = 10.620, p < 0.01) remained associated with MOOP. Conclusion This study suggests that health literacy is significantly associated with medical expenditure. The adoption of disease prevention measures and the utilization of public health services are important elements. Improving health literacy should be give more importance in health promotion and public education for the general public.