ACCESS BARRIERS: LANGUAGE IS A GROWING PROBLEM
"As the population of the United States becomes ever moreThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
diverse and the languages spoken multiply, growing numbers of
patients who speak no English are being isolated by language
barriers," the New York Times reports. In efforts to communicate
with non-English speaking patients, hospitals "have hired more
bilingual staff members and compiled lists of employees who speak
other languages." However, because full-time interpreters are
expensive, and because there are hundreds of languages spoken in
areas like New York City, hospitals are having difficulty
communicating with every patient, leading health care
professionals to "hunt down volunteers, sometimes patients'
children, or even bystanders in the emergency room" to facilitate
communication.
RESULTING PROBLEMS
The Times reports that doctors' inability to communicate
with patients leads to missed diagnoses, misunderstandings about
the course of treatment, and often causes doctors to conduct too
many tests, "some very expensive, others potentially risky." Dr.
Steven Davidson, chief of emergency services at Maimonides
Medical Center in Brooklyn, said, "When you can't speak to your
patients in their native language, you do the best you can. But
no system of translation will ever be foolproof and you will
never be able to duplicate that trust you establish when you
speak the same language." Another problem is that patients may
withhold embarrassing information from children and other family
members who act as interpreters, often omitting critical
information about symptoms and compromising their care.
According to the Times, the biggest problem resulting from
inadequate medical interpreting may be "that it discourages
people with limited or no English -- many of whom are poor and at
greater risk for certain diseases -- from seeking preventive
care." Heike Thiel de Bocanegra, project director of the New
York Task Force on Immigrant Health, said, "If you cannot talk or
communicate with the person who is supposed to be giving you
care, you are going to stop seeking it, but you are not going to
stop getting sick."
ENFORCEMENT
The Times notes that the "federal government and many
states, including New York, require hospitals to provide
interpreters or risk losing Medicaid and Medicare
reimbursements." However, regulations governing this requirement
"are vague and enforcement is difficult." "In most cases," the
Times notes, "hiring some bilingual employees is enough to stave
off a complaint. And most violations are never discovered, since
immigrants who speak no English frequently do not know their
rights or are reluctant to file complaints." States with the
"most comprehensive services -- California, Washington and
Illinois -- built their programs largely in response to intense
lobbying or the threat of legal action by advocacy groups" (Fein,
11/23).