Crossing the language chasm

Health Affairs

Volumn 24, Issue 2, 2005, Pages 424-434

  Brach, Cindy ^a   Fraser, Irene ^b   Paez, Kathy ^c  

^a AGENCY FOR HEALTHCARE RESEARCH AND QUALITY   (United States)

^b Ctr for Delivery Org and Markets   (United States)

^c JOHNS HOPKINS UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

COMPETENCE; COST BENEFIT ANALYSIS; DIAGNOSTIC TEST; DOCTOR PATIENT RELATION; HEALTH CARE AVAILABILITY; HEALTH CARE COST; HEALTH CARE MANAGEMENT; HEALTH CARE ORGANIZATION; HEALTH CARE PLANNING; HEALTH CARE POLICY; HEALTH CARE QUALITY; HEALTH CARE SYSTEM; HEALTH PROGRAM; HEALTH SERVICES RESEARCH; HEALTH STATISTICS; INTERPERSONAL COMMUNICATION; LANGUAGE ABILITY; LINGUISTICS; MEDICAID; MEDICAL EDUCATION; MEDICAL PRACTICE; PATIENT SATISFACTION; PHYSICIAN; PREVENTIVE HEALTH SERVICE; PREVENTIVE MEDICINE; PUBLIC HEALTH SERVICE; PURCHASING; REVIEW; UNITED STATES; WELLBEING;

COMMUNICATION BARRIERS; HUMANS; LANGUAGE; PATIENT EDUCATION; PHYSICIANS; PROFESSIONAL COMPETENCE; UNITED STATES;

EID: 17244368863     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.24.2.424     Document Type: Review

References (42)

1. K.S. Collins et al., Diverse Communities, Common Concerns: Assessing Health Care Quality for Minority Americans (New York: Commonwealth Fund, 2002).
2. Calculated from U.S. Bureau of the Census, "Census 2000 Supplementary Survey, P035, Age by Language Spoken at Home by Ability to Speak English for the Population Five Years and Over," in Census 2000 Supplementary Survey Summary Tables (Washington: U.S. Bureau of the Census, 2002). Although these figures presumably include those who speak American Sign Language (ASL), and many of the findings of this paper may be relevant to ASL speakers, this research focused on speakers of foreign languages and does not spe cifically address deafness or other disabilities as a source of language barriers.
3. M.A. Stewart, "Effective Physician-Patient Communication and Health Outcomes: A Review," Journal of the Canadian Medical Association 152, no. 9 (1995): 1423-1433.
4. For extensive reviews of the literature, see J. P. Fortier and D. Bishop, Setting the Agenda for Research in Cultural Competence in Health Care, ed. C. Brach (Rockville, Md.: Office of Minority Health and Agency for Healthcare Research and Quality, 2004); E.A. Jacobs et al., Language Barriers in Health Care Settings: An Annotated Bibliography of the Research Literature (Woodland Hills, Calif.: California Endowment, 2003); and C. Brach and I. Fraser, "Can Cultural Competency Reduce Racial and Ethnic Health Disparities? A Review and Conceptual Model," Medical Care Research and Review 57, Supp. 1 (2000): 181-217.
5. For extensive reviews of the literature, see J. P. Fortier and D. Bishop, Setting the Agenda for Research in Cultural Competence in Health Care, ed. C. Brach (Rockville, Md.: Office of Minority Health and Agency for Healthcare Research and Quality, 2004); E.A. Jacobs et al., Language Barriers in Health Care Settings: An Annotated Bibliography of the Research Literature (Woodland Hills, Calif.: California Endowment, 2003); and C. Brach and I. Fraser, "Can Cultural Competency Reduce Racial and Ethnic Health Disparities? A Review and Conceptual Model," Medical Care Research and Review 57, Supp. 1 (2000): 181-217.
6. For extensive reviews of the literature, see J. P. Fortier and D. Bishop, Setting the Agenda for Research in Cultural Competence in Health Care, ed. C. Brach (Rockville, Md.: Office of Minority Health and Agency for Healthcare Research and Quality, 2004); E.A. Jacobs et al., Language Barriers in Health Care Settings: An Annotated Bibliography of the Research Literature (Woodland Hills, Calif.: California Endowment, 2003); and C. Brach and I. Fraser, "Can Cultural Competency Reduce Racial and Ethnic Health Disparities? A Review and Conceptual Model," Medical Care Research and Review 57, Supp. 1 (2000): 181-217.
7. L. Hampers and J. McNulty, "Professional Interpreters and Bilingual Physicians in a Pediatric Emergency Department: Effect on Resource Utilization," Archives of Pediatrics and Adolescent Medicine 156, no. 11 (2002): 1108-1113.
8. Ibid.; L.C. Hampers et al., "Language Barriers and Resource Utilization in a Pediatric Emergency Department," Pediatrics 103, no. 6, Part 1 (1999): 1253-1256; and E.D. Lee et al., "Does a Physician-Patient Language Difference Increase the Probability of Hospital Admission?" Academic Emergency Medicine 5, no. 1 (1998): 86-89.
9. Ibid.; L.C. Hampers et al., "Language Barriers and Resource Utilization in a Pediatric Emergency Department," Pediatrics 103, no. 6, Part 1 (1999): 1253-1256; and E.D. Lee et al., "Does a Physician-Patient Language Difference Increase the Probability of Hospital Admission?" Academic Emergency Medicine 5, no. 1 (1998): 86-89.
10. Ibid.; L.C. Hampers et al., "Language Barriers and Resource Utilization in a Pediatric Emergency Department," Pediatrics 103, no. 6, Part 1 (1999): 1253-1256; and E.D. Lee et al., "Does a Physician-Patient Language Difference Increase the Probability of Hospital Admission?" Academic Emergency Medicine 5, no. 1 (1998): 86-89.
11. C. Brach and I. Fraser, "Reducing Disparities through Culturally Competent Health Care: An Analysis of the Business Case," Quality Management in Health Care 10, no. 4 (2002): 15-28.
12. Hampers and McNulty, "Professional Interpreters"; and A. Manson, "Language Concordance as a Determinant of Patient Compliance and Emergency Room Use in Patients with Asthma," Medical Care 26, no. 12 (1988): 1119-1128.
13. Hampers and McNulty, "Professional Interpreters"; and A. Manson, "Language Concordance as a Determinant of Patient Compliance and Emergency Room Use in Patients with Asthma," Medical Care 26, no. 12 (1988): 1119-1128.
14. E.A. Jacobs et al., "The Impact of Interpreter Services on Delivery of Care to Limited-English-Proficient Patients," Journal of General Internal Medicine 16, no. 7 (2001): 468-474; E.A. Jacobs et al., "Overcoming Language Barriers in Health Care: Costs and Benefits of Interpreter Services," American Journal of Public Health 94, no. 5 (2004): 866-869; R. Rivadeneyra et al., "Patient Centeredness in Medical Encounters Requiring an Interpreter," American Journal of Medicine 108, no. 6 (2000): 470-474; and D.W. Baker, R. Hayes, and J.P. Fortier, "Interpreter Use and Satisfaction with Interpersonal Aspects of Care for Spanish-Speaking Patients," Medical Care 36, no. 10 (1998): 1461-1470.
15. E.A. Jacobs et al., "The Impact of Interpreter Services on Delivery of Care to Limited-English-Proficient Patients," Journal of General Internal Medicine 16, no. 7 (2001): 468-474; E.A. Jacobs et al., "Overcoming Language Barriers in Health Care: Costs and Benefits of Interpreter Services," American Journal of Public Health 94, no. 5 (2004): 866-869; R. Rivadeneyra et al., "Patient Centeredness in Medical Encounters Requiring an Interpreter," American Journal of Medicine 108, no. 6 (2000): 470-474; and D.W. Baker, R. Hayes, and J.P. Fortier, "Interpreter Use and Satisfaction with Interpersonal Aspects of Care for Spanish-Speaking Patients," Medical Care 36, no. 10 (1998): 1461-1470.
16. E.A. Jacobs et al., "The Impact of Interpreter Services on Delivery of Care to Limited-English-Proficient Patients," Journal of General Internal Medicine 16, no. 7 (2001): 468-474; E.A. Jacobs et al., "Overcoming Language Barriers in Health Care: Costs and Benefits of Interpreter Services," American Journal of Public Health 94, no. 5 (2004): 866-869; R. Rivadeneyra et al., "Patient Centeredness in Medical Encounters Requiring an Interpreter," American Journal of Medicine 108, no. 6 (2000): 470-474; and D.W. Baker, R. Hayes, and J.P. Fortier, "Interpreter Use and Satisfaction with Interpersonal Aspects of Care for Spanish-Speaking Patients," Medical Care 36, no. 10 (1998): 1461-1470.
17. E.A. Jacobs et al., "The Impact of Interpreter Services on Delivery of Care to Limited-English-Proficient Patients," Journal of General Internal Medicine 16, no. 7 (2001): 468-474; E.A. Jacobs et al., "Overcoming Language Barriers in Health Care: Costs and Benefits of Interpreter Services," American Journal of Public Health 94, no. 5 (2004): 866-869; R. Rivadeneyra et al., "Patient Centeredness in Medical Encounters Requiring an Interpreter," American Journal of Medicine 108, no. 6 (2000): 470-474; and D.W. Baker, R. Hayes, and J.P. Fortier, "Interpreter Use and Satisfaction with Interpersonal Aspects of Care for Spanish-Speaking Patients," Medical Care 36, no. 10 (1998): 1461-1470.
18. T.M. Tocher and E. Larson, "Quality of Diabetes Care for Non-English-Speaking Patients: A Comparative Study," Western Journal of Medicine 168, no. 6 (1998): 504-511.
19. Hampers and McNulty, "Professional Interpreters"; and J. Bernstein et al., "Trained Medical Interpreters in the Emergency Department: Effects on Services, Subsequent Charges, and Follow-up," Journal of Immigrant Health 4, no. 4 (2002): 171-176.
20. Hampers and McNulty, "Professional Interpreters"; and J. Bernstein et al., "Trained Medical Interpreters in the Emergency Department: Effects on Services, Subsequent Charges, and Follow-up," Journal of Immigrant Health 4, no. 4 (2002): 171-176.
21. Jacobs et al., "Overcoming Language Barriers."
22. M.Q. Patton, Qualitative Evaluation and Research Methods (Newbury Park, Calif.: Sage, 1990). Because California is a large and diverse state that, in terms of linguistic cultural and competence, is ahead of much of the country, a disproportionate share of study health plans was located in California.
23. COSMOS Corporation, National Study of Culturally and Linguistically Appropriate Services in Managed Care Organizations (CLAS in MCOs Study): Final Report, Executive Summary (Rockville, Md.: OMH, 2003).
24. K. Quan, "Assessing the Impact of Physician-Patient Communication Barriers on Health Care Costs and Quality," Presented to the OMH Expert Panel, Rockville, Md., 16 October 2003.
25. K. Paez, Providing Oral Linguistic Services: A Guide for Managed Care Plans (Baltimore: Centers for Medicare and Medicaid Services, 2002).
26. P.B. Bach et al., "Primary Care Physicians Who Treat Blacks and Whites," New England Journal of Medicine 351, no. 6 (2004): 575-584; and A.M. Epstein, "Health Care in America - Still Too Separate, Not Yet Equal," New England Journal of Medicine 351, no. 6 (2004): 603-605.
27. P.B. Bach et al., "Primary Care Physicians Who Treat Blacks and Whites," New England Journal of Medicine 351, no. 6 (2004): 575-584; and A.M. Epstein, "Health Care in America - Still Too Separate, Not Yet Equal," New England Journal of Medicine 351, no. 6 (2004): 603-605.
28. For example, the average number of interpreted visits in one study was 2.95 per year. Jacobs et al., "Overcoming Language Barriers." While the cost of interpreter services varies, the Office of Management and Budget (OMB) estimates that in-person professional interpreter services cost $20-$26 per hour. The OMB also cites decreases in number and severity of misdiagnoses or other medical errors that are costly to providers and insurance companies and obtaining true informed consent that can lead to legal and other problems as possible cost offsets. Office of Management and Budget, Report to Congress: Assessment of the Total Benefits and Costs of Implementing Executive Order No. 13166: Improving Access for Persons with Limited English Proficiency (Washington: OMB, 2002).
29. For example, the average number of interpreted visits in one study was 2.95 per year. Jacobs et al., "Overcoming Language Barriers." While the cost of interpreter services varies, the Office of Management and Budget (OMB) estimates that in-person professional interpreter services cost $20-$26 per hour. The OMB also cites decreases in number and severity of misdiagnoses or other medical errors that are costly to providers and insurance companies and obtaining true informed consent that can lead to legal and other problems as possible cost offsets. Office of Management and Budget, Report to Congress: Assessment of the Total Benefits and Costs of Implementing Executive Order No. 13166: Improving Access for Persons with Limited English Proficiency (Washington: OMB, 2002).
30. Mara Youdelman, staff attorney, National Health Law Program, personal communication, 23 September 2004.
31. S. Rosenbaum and J. Teitelbaum, Cultural Competence in Medicaid Managed Care Purchasing: General and Behavioral Health Services for Persons with Mental and Addiction-Related Illnesses and Disorders (Washington: George Washington University Medical Center, 1999).
32. California Office of the Patient Advocate, HMO Services in Other Languages (Sacramento: California OPA, 2003).
33. Brach and Fraser, "Reducing Disparities through Culturally Competent Health Care."
34. National Committee on Vital and Health Statistics, Letter to HHS Secretary Thompson on racial and ethnic disparities in health care, 26 September 2003, www.ncvhs.hhs.gov/030926ltb.htm (13 December 2004); and National Committee on Vital and Health Statistics, Letter to HHS Secretary Thompson on improving population-based data for racial and ethnic minorities, 27 March 2003, www.ncvhs.hhs.gov/030327lt.htm (14 December 2004).
35. National Committee on Vital and Health Statistics, Letter to HHS Secretary Thompson on racial and ethnic disparities in health care, 26 September 2003, www.ncvhs.hhs.gov/030926ltb.htm (13 December 2004); and National Committee on Vital and Health Statistics, Letter to HHS Secretary Thompson on improving population-based data for racial and ethnic minorities, 27 March 2003, www.ncvhs.hhs.gov/030327lt.htm (14 December 2004).
36. Centers for Medicare and Medicaid Services, "Medicare+Choice Organizations' (M+CO) National Quality Assessment and Performance Improvement (QAPI) for the Years 2002 and 2003," July 2001, www.cms.hhs.gov/ healthplans/opl/opl133.pdf (25 January 2005).
37. National Health Law Program, "Assessment of State Laws, Regulations and Practices Affecting the Collection and Reporting of Racial and Ethnic Data by Health Insurers and Managed Care Plans," 7 January 2004, www.omhrc.gov/omh/sidebar/datastats13.htm (13 December 2004).
38. Joint Commission on Accreditation of Healthcare Organizations, "Hospitals, Language, and Culture: A Snapshot of the Nation," January 2004, www.jcaho.org/about+us/hlc/home.htm (30 November 2004).
39. Fortier and Bishop, Setting the Agenda.
40. For example, see OMH, "A Practical Guide for Implementing the Recommended National Standards for Culturally and Linguistically Appropriate Services in Health Care," www.omhrc.gov/clas/guide2a.asp (14 December 2004); Federal Interagency Working Group on Limited English Proficiency, "Language Assistance Self-Assessment and Planning Tool for Recipients of Federal Financial Assistance," www.lep.gov/selfassesstool.htm (30 November 2004); and M. Youdelman and J. Perkins, Providing Language Interpretation Services in Health Care Settings: Examples from the Field, May 2002, www.healthlaw.org/pubs/cmwfreport0502.pdf (14 December 2004).
41. For example, see OMH, "A Practical Guide for Implementing the Recommended National Standards for Culturally and Linguistically Appropriate Services in Health Care," www.omhrc.gov/clas/guide2a.asp (14 December 2004); Federal Interagency Working Group on Limited English Proficiency, "Language Assistance Self-Assessment and Planning Tool for Recipients of Federal Financial Assistance," www.lep.gov/selfassesstool.htm (30 November 2004); and M. Youdelman and J. Perkins, Providing Language Interpretation Services in Health Care Settings: Examples from the Field, May 2002, www.healthlaw.org/pubs/cmwfreport0502.pdf (14 December 2004).
42. For example, see OMH, "A Practical Guide for Implementing the Recommended National Standards for Culturally and Linguistically Appropriate Services in Health Care," www.omhrc.gov/clas/guide2a.asp (14 December 2004); Federal Interagency Working Group on Limited English Proficiency, "Language Assistance Self-Assessment and Planning Tool for Recipients of Federal Financial Assistance," www.lep.gov/selfassesstool.htm (30 November 2004); and M. Youdelman and J. Perkins, Providing Language Interpretation Services in Health Care Settings: Examples from the Field, May 2002, www.healthlaw.org/pubs/cmwfreport0502.pdf (14 December 2004).