Meanwhile in LMICs the cost of providing health literacy to an entire population may be lower, and the dividend greater given the likelihood of less reliable access to care and thus greater emphasis of self-care in these settings. Nevertheless, involving patients in their care and in helping measure and assess the safety of their care is very important, and is supported by the literature. The care experience predominantly concerns the quality of communication. The previously cited study by Tsang et al (2013) suggests a long-standing relationship between patients and providers improves safety over time.