A survey examines how providers meet the language needs of patients with limited English proficiency.
|Juliet Yonek||Cynthia Hedges Greising|
Hospitals and health systems are encountering increasing numbers of patients with limited English proficiency (LEP). For these patients, language and communication barriers pose a serious threat to receiving safe, high-quality health care. Numerous studies have shown that language barriers impede access to health care, compromise quality of care and increase the risk of adverse health outcomes.
To better understand what hospitals and systems are doing to meet the language needs of their LEP patients, the Health Research & Educational Trust (HRET) conducted a national survey of hospitals in collaboration with the National Health Law Program; the California Endowment funded the survey. In this survey, 63 percent of the hospitals reported that they treat LEP patients either daily or weekly. An additional 17 percent reported treating LEP patients at least monthly.
Respondents were also queried about what languages they encountered, how they determine the language needs of LEP patients, what resources they use to provide language services, what barriers prevent them from providing such services, and what tools and training would help them provide these services.
The U.S. Census Bureau’s 2005 American Community Survey data show that between 1990 and 2005, the percentage of Americans speaking a language other than English at home rose from 14 percent to more than 19 percent.
Estimates of the number of people with LEP range from a low of about 12 million--those who speak English “not well” or “not at all”--to more than 23 million people, including those who speak English less than “very well.”
Hospitals reported encountering a handful of languages on a frequent basis. Of the 32 languages listed in the survey, at least 20 percent of all respondents reported encountering 15 of the languages frequently. The most frequently encountered languages were Spanish (93 percent), Chinese (47 percent), Vietnamese (39 percent), Japanese (37 percent), Korean (37 percent) and Russian (37 percent). In addition, hospitals wrote in languages not listed on the survey. Of these write-in responses, American Sign Language was specified the most frequently.
To help hospitals communicate effectively with diverse populations, HRET and other organizations recommend that they collect information about the languages spoken by the populations they serve. (The Joint Commission recently began requiring hospitals to collect this information as part of its accreditation process.) The results from this survey indicate that many hospitals are routinely collecting language data both from patients (46 percent) and from the community (52 percent). By doing so, hospitals can also substantiate their plea for resources and reimbursement that would help provide language services to all LEP patients.
Hospitals identified staff members and other resources available to them for providing language services. Ninety-two percent of the hospitals indicated the availability of telephone interpreter services, and 82 percent specified bilingual clinical staff.
External interpretation agencies, staff interpreters and community language banks were less prevalent. Interestingly, although staff interpreters were reported as less available than telephonic services, they are the most frequently used resource when available: Eighty-two percent of hospitals use interpreters.
A major obstacle to providing language services is that most insurers do not pay for interpretation and related services such as written translations or phone interpretation.
In addition, although Title VI requires most providers to offer language services free of charge to LEP patients, the government provides little or no direct reimbursement. Medicare and most private insurers do not pay for interpretation, but both payers serve large numbers of LEP beneficiaries.
We asked hospitals how they pay for language services and from which sources they receive direct reimbursement. Only 3 percent of the hospitals receive direct reimbursement for providing language services. Of the 3 percent that receive reimbursement, the primary source is Medicaid (78 percent). Thus, funding language services is largely the hospital’s responsibility.
Concerns over the cost of providing language services and receiving reimbursement in return were indicated as a barrier by 48 percent of the respondents.
Another major barrier that hospitals cited to providing language services is the absence of a method for identifying patients who need language services before they arrive at the hospital. Fifty-three percent of hospitals reported that they currently have no means to accomplish this.
We presented respondents with a list of tools and training that could facilitate or improve the provision of language services.
Of the hospitals surveyed, 58 percent indicated that packaged in-service training programs would be a helpful tool, and 50 percent selected model approaches/promising practices for serving LEP patients as useful.
Seventy-nine percent of respondents indicated that training on how to respond to patients and family members who do not speak English would help, as would cultural competency training (77 percent).
As the population of LEP individuals continues to grow, so does the need for accessible, high-quality language services in all health care settings. Health outcomes and satisfaction for LEP individuals improve when hospitals and systems use trained professional interpreters, bilingual providers and other language services.
The HRET survey shows that hospitals and health systems need payment from government programs for LEP beneficiaries, a source for promising practices and training materials, and help using census and language data. With these resources and training, providers will be better prepared to deliver safe, high-quality health care to all their LEP patients.
Juliet Yonek, M.P.H., is biostatistician and Cynthia Hedges Greising is staff writer, both at the Health Research & Educational Trust.
The full report, “Hospital Language Services for Patients with Limited English Proficiency: Results from a National Survey,” can be accessed at www.hret.org/languageservices.
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