ArticleBMC health services research2022
The economic costs of limited health literacy in China: evidence from China's National Health Literacy Surveillance data.
Article in BMC health services research, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
9 citing papers in PubMed, 2 syntheses or guidelines pooled it, 16 citations in OpenAlex.
- What is the impact of health literacy on healthcare costs? A systematic review and evidence synthesis.BMJ open · 2025Pooled it
- Identifying Strengths and Weaknesses in Health Literacy among Medical Students: A Systematic Review.BMC medical education · 2025Pooled it
- The association between health literacy and out-of-pocket health expenditure: exploring heterogeneity by chronic disease in Zhejiang, China.International journal for equity in health · 2026Article
- The impact of health literacy on healthcare spending: theory and evidence from China.International journal of health economics and management · 2026Article
- Health literacy profiles of undergraduate health students in Brazil: a cluster analysis.BMC medical education · 2025Article
- Health literacy and quality of life of riverine populations in primary health care.Revista latino-americana de enfermagem · 2025Article
- Development and validation of a Systemic Sclerosis Health Literacy Scale.Frontiers in public health · 2023Article
- Changes in the health literacy of residents aged 15-69 years in central China: A three-round cross-sectional study.Frontiers in public health · 2023Article
- The development and progress of health literacy in China.Frontiers in public health · 2022Review
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundLimited health literacy is a public health challenge contributing to the rising health care costs. We assess the economic costs of limited health literacy in China using data from the National Health Literacy Surveillance survey.
methodsOur data includes a sample of 6316 residents aged 15-69 years old living in Ningbo, China, in 2019. We use box plots to examine the distribution of out-of-pocket health expenditure by the level of health literacy. We then use the estimates from a two-part model to assess the contribution of limited health literacy to individual medical spending and the aggregate health expenditure at different levels of health literacy for the adult population in Ningbo.
resultsMedical costs of limited health literacy are about 10% (177 CNY or about 25 USD) of the annual medical expense of a resident aged 15-69 living in Ningbo. The medical cost of limited health literacy is greater among the rural, female, and older groups than others. If the proportion of people with adequate health literacy increases from 22 to 30% (the target level by 2030), the aggregate out-of-pocket health expenditure in Ningbo will decrease by 100 million CNY (14 million USD), or 0.88% of the 2019 Ningbo government expenditure on health care.
conclusionsThis paper highlights the direct and indirect economic costs associated with limited health literacy. The results should help policymakers evaluate the cost-effectiveness of relevant programs that aim to improve residents' health literacy.
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