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Language Barrier Affecting Health Care

Proper Medical Care May Be Hampered by Lack of Qualified Interpreters

WebMD Health News

July 19, 2006 -- Identifying autismautism in a very young child is difficult under the best of circumstances, but Nelsinia Ramos faced a special challenge seven years ago when she sought a diagnosis to explain her young daughter Jennifer's developmental delays.

Ramos spoke little English, but she was determined to find out what was wrong with her daughter, who was not yet 2.

"The language barrier added to the frustration because I couldn't really explain what was going on with her, even though I tried my best," says Ramos, who now speaks fluent English.

Some 50 million people living in the U.S. speak languages other than English in their homes, and 22 million speak only limited English.

For many, access to health care is limited by their inability to communicate their medical needs, in large part because of a lack of qualified interpreters in the nation's hospitals, says Glenn Flores, MD, who has long studied the problem.

"We are not providing the best care to patients when language barriers aren't being addressed," he tells WebMD. "This is a quality of care issue, and it makes both ethical and economic sense to address it."

13 States Require Reimbursement

In an editorial appearing in Thursday's New England Journal of Medicine, Flores called on federal and state officials to enforce a federal mandate requiring language assistance for patients with limited English proficiency.

Thirteen states currently require third-party reimbursement for hospital-based interpreters, but they are not the states that need such laws most, Flores says.

"The states with the largest non-English-speaking populations don't have these requirements," he says.

A survey of hospitals in New Jersey, where a quarter of the population speaks a language other than English in their homes, revealed that only 3% provided full-time interpreters. That translates to one interpreter for every 235,260 people, Flores says.

When interpreters aren't available, health care providers tend to rely on bilingual family members, friends, or even hospital staffers who aren't trained medical interpreters. A study of interpreter-caused medical errors, conducted by Flores and colleagues, found that more than three-quarters, or 77%, involved nonprofessional interpreters.

The school-aged children of immigrants often serve as interpreters for their parents because they tend to be more fluent in English. This practice presents special problems in the health care setting, Flores adds.

Interpreters Cost Effective

The U.S. Office of Management and Budget estimates the cost of providing adequate language services to everyone who needs them to be around $4 more for each doctor visit during emergency department, inpatient, outpatient, and dental visits.

Flores says providing these services would save health care dollars by preventing unnecessary hospitalizations and treatments.

In 1997, emergency medicine specialist Louis Hampers compared the care given to patients at a Chicago hospital who were not fluent in English to the care given those who were.

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