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Overcoming Language Barriers in Health Care Interactions

Wednesday, April 08, 2009

Contact: Cheryl Pedersen, (609) 275-2258

WASHINGTON, D.C. (April 8, 2009)-More than 23 million Americans have limited English proficiency (LEP), which complicates their ability to obtain quality health care. Language barriers in the health care setting can lead to miscommunications and cause medical errors, delay or denial of services, issues with medication management, and underutilization of preventive services. A new policy brief from Mathematica Policy Research, Inc., assesses emerging national efforts to address language barriers and profiles work in three states-California, Minnesota, and New York-to highlight challenges, successes, and implications for future policy and activities related to providing language services.

As the country's demographics and immigration patterns change, more states are establishing regulations and policies to promote access to interpreters and translation services in health care. In 2008, all 50 states had at least two laws in place on providing these services in health care settings, up from 43 states in 2006. However, the laws vary greatly. California, Minnesota, and New York have been at the forefront of these efforts and are considered leaders in providing language services.

California, with a large number of active consumer advocacy groups and awareness among policy leaders of the issues for individuals with limited English proficiency, is the only state that has passed a law requiring commercial health plans to provide language services at all points of patient contact. The state's greatest challenge so far has been setting up and reworking information technology systems to support the collection and management of data on patients' primary written and spoken languages.

In response to a large increase in its foreign-born population, Minnesota has been active in efforts to provide, fund, and improve the quality of language services in health care settings. The state reimburses Medicaid providers for language services and has considered methods for funding these services in commercial markets as well. It is also one of a handful of states developing certification standards for interpreter services to ensure quality.

New York's sizeable immigrant population is concentrated in and around New York City, which has a history of focused advocacy efforts, community activities, and regulation of language services. Advocacy groups and state legislators have been working on legislation to reimburse language services in Medicaid. Increasing awareness statewide of the need for language services might add momentum as immigrant populations grow in areas outside of New York City.

The authors identify three challenges to developing language services in the health care setting:

Promoting appropriate use of services. Clinical staff need training to help them determine when to request a medical interpreter.

Ensuring quality. Unqualified interpreter services during a medical encounter-for example, interpretation by a bilingual relative of the patient-usually do not benefit the patient and, in fact, might result in increased medical errors and poor adherence to clinical instructions.

Developing payment mechanisms. Determining how to pay for language services is challenging, particularly for states working to extend services to LEP residents through health plans. States may benefit from examining payment mechanisms developed in states already active in language services.
"As more states embark on activities related to language services," said Melanie Au, lead author of the brief and a research analyst at Mathematica, "developing standards for the quality of these services could help ensure their effectiveness."

The study was funded by the Agency for Healthcare Research and Quality. "Improving Access to Language Services in Health Care: A Look at National and State Efforts," by Au, Erin Fries Taylor, and Marsha Gold is available at

Mathematica, a nonpartisan research firm, conducts high-quality, objective policy research and surveys to improve public well-being. Its clients include federal and state governments, foundations, and private-sector and international organizations. The employee-owned company, with offices in Princeton, N.J., Washington, D.C., Cambridge, Mass., Ann Arbor, Mich., and Oakland, Calif., has conducted some of the most important studies of health care, education, welfare, employment, nutrition, and early childhood policies and programs in the U.S.

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