Research amply documents that language barriers impede access to health care, compromise quality of care, and increase the risk of adverse health outcomes among patients with limited English proficiency. Federal civil rights policy obligates health care providers to supply language services, but wide gaps persist because insurers typically do not pay for interpreters, among other reasons. Health care financing policies should reinforce existing medical research and legal policies: Payers, including Medicaid, Medicare, and private insurers, should develop mechanisms to pay for interpretation services for patients who speak limited English. 1 Health care providers are encountering rising numbers of patients who have limited English proficiency (LEP), defined as speaking English less than very well or not at all. For example, U.S. census data show that between 1990 and 2000, the percentage of Americans (older than age five) speaking a language other than English at home rose from 13.8 percent to 17.8 percent, and the LEP population grew by one-third, from 6.1 percent to 8.1 percent.
2Title VI of the Civil Rights Act obligates medical caregivers to provide interpretation and translation services so that LEP patients can have access to health care services equal to that of English speakers; this constitutes a protection against discrimination based on national origin.3 But the regrettable truth is that thousands of patients face language barriers every day, either because they cannot communicate with their medical caregivers or because communication is distorted by poorly trained, inexperienced, or inappropriate (for example, child) interpreters. This can be a problem whether the patient speaks Spanish-the language spoken I n t e r p r e t e r S e r v i c e s H E A LT H A F F A I R S~Vo l u m e 2 4 , N u m b e r 2 4 3 5