Pay Now Or Pay Later: Providing Interpreter Services In Health Care

Abstract

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

Ethnic Disparities in Self-Reported Oral Health Status and Access to Care among Older Adults in NYC

“…Numerous studies have found that communication barriers can adversely affect access to medical health services, health outcomes, and patient satisfaction. [15][16][17][18] The association between dental healthcare utilization and/or satisfaction with dental care and language proficiency, which is often used as a proxy for FIGURE 1. Self-reported dental status, dental care utilization, and dental insurance, by race/ ethnicity, adults age 60+ attending senior centers, New York City, 2004.…”

Consent by Proxy for Nonurgent Pediatric Care

“…A similar approach may be needed for patients or LARs with hearing impairment. 52 LEP has the potential to become a major future medical malpractice issue relating to informed consent, 53 which will be compounded in scenarios that involve consent by proxy. Various federal and state laws and regulations apply to individuals with LEP, including the American With Disabilities Act, the Rehabilitation Act of 1973, Title VI of the Civil Rights Act, and the Health Insurance Portability and Accountability Act (HIPAA).…”

Getting to Equal: Strategies to Understand and Eliminate General and Orthopaedic Healthcare Disparities

“…Community-based efforts, such as efforts in the San Francisco Chinese community and the South Bronx Health REACH program, can identify and eliminate healthcare disparities at the local level using a multifaceted approach including promotion of (1) universal health insurance coverage (2) culturally competent care for all, (3) an end to segregation in health facilities based on insurance status, (4) accountability for state uncompensated care funds, (5) greater health workforce diversity, (6) an expansion of public health education, and (7) environmental justice [16,77] Leverage government influence to reduce healthcare disparities Using a quality improvement framework to address racial and ethnic disparities, federal and state governments can, collectively as the largest US healthcare payers, exert policy leverage to demand the reduction of healthcare disparities [24,48] Assess and monitor organizations' cultural care preparedness The Accreditation Council on Graduate Medical Education requires as ''core competencies'' that medical residents must demonstrate sensitivity and responsiveness to the culture, age, gender, and disabilities of patients and fellow healthcare professionals [53] Expand and monitor healthcare civil rights enforcement The unfinished parts of the civil rights-era agenda, the persistence of more subtle forms of segregation, and the failure to assure nondiscriminatory treatment pose major challenges to current efforts to eliminate health care disparities [61,62] Expand the use of qualified interpreters Linguistic competence, including the availability and quality of interpreter services, impacts healthcare quality [14,38,42] Finally, in addition to the influence they can exert as major payors for healthcare services [24], state and local governments must leverage their administrative, regulatory, and legislative capacities for reduction of healthcare disparities. This can be accomplished by more broadly disseminating legal and regulatory standards for cultural competence [48], public health efforts [58,59], data collecting and monitoring of changes in healthcare disparities [50,66], promoting relevant research, and enforcing civil rights laws [62].…”