Interpreter services improve care and payment
New research shows that when hospitals increase interpreter services for uninsured patients who have limited English proficiency, quality of care improves and there’s a better chance the hospital will receive at least some payment for services provided. Although federal funding for interpreter services is available from the Centers for Medicare & Medicaid Services, only five states use it.
A national survey of uninsured people, conducted by The Access Project, a Brandeis University-affiliated national resource center for local groups wanting to improve access to health care, found that a significant portion of respondents who need an interpreter but did not get one left the hospital without understanding how to take prescribed medications.
Report author Dennis Andrulis, a research professor at the State University of New York Downstate Medical Center in Brooklyn, says the patients "are sending a strong message that failure to communicate effectively may cost patients their health and be bad business for doctors and hospitals."
Access Project director Mark Rukavina tells of a Hispanic man from Virginia who was prescribed three medications and mistakenly assumed he should take all three at once. He ended up in a hospital emergency department with a severe reaction. Only then was an interpreter found to instruct the man how to take the medications as prescribed.
Mr. Andrulis says the survey results strongly suggest that having an interpreter may help non-English speaking patients find financial assistance to pay for medical care. More than half the survey respondents who needed but did not receive interpreters said they were never asked if they needed help in paying for medical care; compare that with slightly more than a third who needed and got an interpreter.
The report says the finding on medications has serious implications for a U.S. health system that is struggling to improve the quality of care for an increasingly diverse population. For patients not fluent in English, the lack of an interpreter could lead to misdiagnosis and negative health outcomes.
"This is a wake-up call for hospitals that are worried about malpractice suits," Mr. Rukavina said. "If they care about preventing medical errors, they’ll pay close attention to our finding that there is a strong association between interpreters and understanding medical instructions."
The issue is becoming increasingly important in light of census data showing the doubling of Hispanic populations in 22 states during the past 10 years. More than 30 million people, or 11% of the U.S. population, are foreign-born and many have limited English proficiency.
Mr. Rukavina says the survey concludes that interpreters should be more widely available. "Hospitals and doctors must work together to ensure interpreter services are there for patients who don’t speak English well," he says. "Patients should be offered interpreter services at no cost. This is required by the Civil Rights Act of 1964, and these services should be funded. The federal government provides funding to states for interpreters through Medicaid and [State Childrens Health Insurance Program], but only five states have used this funding source."
Mr. Rukavina also says that standards for medical interpreters are needed and family members should not be called on to serve as interpreters for their relatives. He recommends that states follow the lead of California and Massachusetts in requiring health care institutions to provide qualified interpreters for people who don’t speak English well.
The third thing the report recommends is more research into the relationship between language barriers and medical errors.
[Contact Mr. Rukavina at (617) 654-9911, ext. 229 and Mr. Andrulis at (718) 270-7726.]
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