The Influence of Health Literacy on the Selection of Healthcare Facilities: An Association Between Health Literacy Level and Number of Healthcare Facilities Visited per Patient per Year Using Real World Data in Japan

OBJECTIVES: As health literacy (HL) is defined as the ability to obtain, understand, and utilize appropriate health and clinical information, individual with higher HL level is expected to select an appropriate healthcare facility for each disease diagnosed. Consequently, individuals with higher HL levels may visit a greater number of facilities than those with lower level who rely on one facility regardless of disease category diagnosed. We examined the relationship between HL level and the number of healthcare facilities visited in one year (2022), considering the number of disease types diagnosed.

METHODS: A database comprising questionnaire data on HL and health insurance claims data provided by DeSC Healthcare Inc. was used. Among individuals covered by employee-based health insurance, those who responded to the HL questionnaire in December 2022 and were enrolled throughout the entire year of 2022 were analyzed. Diagnoses given in 2022 were classified into disease categories of ICD-10. HL level was defined as the first principal component of responses to the questionnaire. A regression model was employed to examine the association between the healthcare facility number visited in 2022 and HL level, gender, age, number of disease categories, and the ordinary logarithm of total medical costs (log costs).

RESULTS: Of 1,137,778 individuals covered by the employee-based health insurance in December 2022, 29,114 individuals had HL data and 27,909 individuals (aged 20–74 years) were identified for the analysis. A greater number of healthcare facilities was associated with female gender (parameter estimate: 0.30), lower age (0.02), number of disease categories (0.43), and log costs (0.45), with statistical significance (p < 0.01) among patients with ≥1 diagnosis. HL level was not associated with the healthcare facility number (-0.00; p = 0.40).

CONCLUSIONS: The influence of HL on the selection of healthcare facilities was not indicated in this study.