Achieving Family Health Literacy: The Case for Insuring Children

One aspect of the SCHIP reauthorization debate that has received more limited attention than it deserves is the relationship between children's health insurance coverage and family health literacy. That is, to what extent is children's health insurance associated with higher health literacy, and to what extent is reduced parental health literacy linked to lower rates of health insurance among children? This association is extremely important, since there is strong evidence of a link between health literacy and the appropriate use of health care. Evidence suggests that when previously uninsured children are covered by health insurance, parents at all income levels make significantly more appropriate use of health care. Expanded health insurance coverage has been shown to be associated with improved access to health care and an increased rate in families who report a regular source of health care. Our findings from the National Assessment of Adult Literacy, a special statistical information system maintained by the National Center for Education Statistics, show that health insurance coverage is associated with significantly higher levels of health literacy. The proportion of parents considered to have proficient health literacy literally doubles among parents of insured children, while the proportion of parents who are able to demonstrate intermediate literacy is more than one-and-a-half times as great when a child is insured. Even more dramatically, the proportion of parents with below-basic literacy is nearly four times as great when children are uninsured. These dramatic findings apply to families who use both public and private health insurance. For example, Medicaid-insured children are nearly 6 times as likely as those without coverage to have a usual source of health care and families whose children are insured through Medicaid are one-fifth as likely as parents whose children are uninsured to report that an emergency room serves as their children's primary source of health care. These findings provide strong support for improving health insurance coverage among children as a means of improving family health literacy. They suggest that all families should have access to continuous, accessible, and affordable coverage for their children. These findings also suggest that in designing health insurance coverage for children, particular emphasis should be placed on helping families understand and use coverage appropriately by incentivizing states to invest in health literacy and clear communications programs for families. The cost of health education for families with children is already recognized as permissible under both Medicaid and SCHIP. Existing …