Research on Language Barriers in Health Care Is Scarce

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Health Care and Language Barriers

Despite numerous studies showing that people who speak little English have less access to health care and receive poorer quality care, there is surprisingly little research on what solutions work best to overcome language barriers to care, according to a review published in The Milbank Quarterly this month.

"Most health care organizations do not provide linguistic assistance services or offer only inadequate services," according to lead researcher Elizabeth Jacobs, M.D., and colleagues.

Health care workers and hospitals that receive federal funding are required by law to find ways to make their care accessible to patients with limited English skills. Many states have similar requirements. However, providers that do offer language-aid services must cobble together programs in the face of scant information about which types of programs work best, usually without reimbursement from public or private insurers, the researchers say.

"Unfortunately, the literature provides little guidance on which interventions, and under which circumstances, best reduce language barriers," said Jacobs, of the John H. Stroger Jr. Hospital and Rush University Medical Center in Chicago.

"Consequently, many health-care purchasers, insurers, regulators and clinicians wonder how or even if they even need to address the issue of language barriers in medical care," she added.

Jacobs and colleagues reviewed 151 scholarly articles on language barriers in health care to find out where the gaps in the current research were most notable.

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The two most common ways to overcome language barriers in health care are to increase the number of doctors and other health care workers who speak the same language as their patients and to use interpreters. The studies suggest that providers who speak the same language as their patients and professional interpreters can improve access to and quality of health care for those with limited English. The studies do not offer guidance on which option is best under specific circumstances, however, which can leave providers in the dark about how to proceed, Jacobs said: "Should they offer incentive pay for bilingual providers, should they hire professional interpreters, or both?"

Only one of the examined studies focused on the quality of medical interpreters, and none of the articles discussed necessary qualifications for interpreters. "This leaves health care stakeholders wondering what type of training, if any, should be required of interpreters and how an interpreter's skill can be evaluated," Jacobs said.

Yolanda Partida, Ph.D., the national program director for Hablamos Juntos, a program to improve health care language services for Latinos, agreed that "there are many challenges with training interpreters, the least of which is that there is no clarity about the role and the skills involved."

Most medical interpreters now get "more of an orientation than training, the kind of guidance you get on the job," Partida said. "Urgency has driven the field of language access. That is why the gold standard is a 40-hour training program."

Partida says well-trained interpreters are essential, "but that does not mean that all language barriers should be addressed with interpreters."

Jacobs and colleagues also found only three studies directly measuring the cost of language barriers, including lost work time, unnecessary doctor visits and medication errors. Jacobs said employers with a high percentage of immigrant workers would especially like to know if these problems are "costing them money."

Jacobs said the lack of federal funding for language barrier studies "has hurt the quantity, quality and rigor of this research." The National Institutes of Health and the Agency for Healthcare Quality and Research should include language barriers in health care as "explicit funding areas," she said.

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