The medical tongue: U.S. laws and policies on language access

Health Affairs

Volumn 27, Issue 2, 2008, Pages 424-433

  Youdelman, Mara K ^a  

^a National Health Law Program   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

HEALTH CARE; HEALTH CARE ACCESS; HEALTH CARE FACILITY; HEALTH CARE ORGANIZATION; HEALTH CARE PERSONNEL; HEALTH CARE POLICY; HEALTH CARE QUALITY; HEALTH CARE SYSTEM; HEALTH CARE UTILIZATION; HEALTH EDUCATION; HEALTH SERVICE; HUMAN; MENTAL HEALTH; OUTCOME ASSESSMENT; REVIEW; TOTAL QUALITY MANAGEMENT; TRAINING;

COMMUNICATION BARRIERS; FEDERAL GOVERNMENT; GOVERNMENT REGULATION; HEALTH SERVICES ACCESSIBILITY; HUMANS; LANGUAGE; STATE GOVERNMENT; UNITED STATES;

EID: 41749091093     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.27.2.424     Document Type: Review

References (50)

1. U.S. Census Bureau, "Selected Characteristics of the Native and Foreign-Born Populations" (Table no. S0602), 2005 American Community Survey (ACS). According to the ACS, 10,422,037 native and naturalized citizens speak English less than "very well." Additionally, 35,352,033 are "foreign-born," not naturalized, but not delineated between documented and undocumented.
2. To determine the percentage of documented foreign-born people, two estimateswere considered: (1) 26 percent of the foreign-born are undocumented [J. Passel, R. Capps, and M. Fix, "Undocumented Immigrants: Facts and Figures," http://www.urban.org/url.cfm?ID=1000587 (accessed 28 December 2007)];
3. and (2) 11.5 million are undocumented [R. Paral, "The Growth and Reach of Immigration: New Census Bureau Data Underscore Importance of Immigrants in the U.S. Labor Force," Immigration Policy Brief, August 2006, http://www.ailf.org/ipc/ipc/policybrief/policybrief_2006_81606.shtml (accessed 28 December 2007)]. This results in a range of 8,950,591-11,259,062 foreign-born documented immigrants. To determine how many have LEP, these numbers were multiplied by 38.7 percent - the percentage of LEP foreign-born naturalized citizens. While a greater percentage of documented immigrants are likely to have LEP than naturalized immigrants are (in part because naturalization requires English competency), this percentage offers a reasonable, if somewhat underinclusive, estimate. The number of LEP foreign-born documented immigrants thus ranges from 3,463,879 to 4,357,257.
4. L. Nielsen-Bohlman, A. Panzer, and D. Kindig, eds., Health Literacy: A Prescription to End Confusion (Washington: National Academies Press, 2004), 4.
5. D.W. Baker et al., "Health Literacy and Mortality among Elderly Persons," Archives of Internal Medicine 167, no. 14 (2007): 1503-1509.
6. E. Jacobs et al., Language Barriers in Health Care Settings: An Annotated Bibliography of the Research Literature, August 2003, http://www.calendow.org/uploadedFiles/language_barriers_health_care.pdf (accessed 3 December 2007).
7. See, for example, 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;
8. S.A. Fox and J.A. Stein, "The Effect of Physician-Patient Communication on Mammography Utilization by Different Ethnic Groups," Medical Care 29, no. 11 (1991): 1065-1082;
9. and Kaiser Commission on Medicaid and the Uninsured, Caring for Immigrants: Health Care Safety Nets in Los Angeles, New York, Miami, and Houston (Washington: Kaiser Commission, February 2001), ii-iii.
10. See also B.D. Smedley, A.Y. Stith, and A.R. Nelson, eds., Unequal Treatment: Confronting Racial and Ethnic Disparities in Health (Washington: National Academies Press, 2003), 71-72. Fifty-one percent of providers believed that patients did not adhere to treatment because of culture or language, but 56 percent reported no cultural competency training.
11. 42 U.S. Code, sec. 2000d.
12. Lau v. Nichols, 414 U.S. 563 (1974).
13. Federal Register 65, no. 159 (16 August 2000): 50121.
14. 45 CFR, sec. 80, app. A (lists examples of federal funding, including Medicare and Medicaid).
15. Federal Register 68, no. 153 (8 August 2003): 47311.
16. Federal Register 65, no. 247 (22 December 2000): 80865;
17. and Office of Minority Health, "National Standards on Culturally and Linguistically Appropriate Services (CLAS)," http://www.omhrc.gov/clas (accessed 30 November 2007).
18. 42 U.S. Code, sec. 1395dd; and 42 CFR, sec. 489.24.
19. 42 U.S. Code, sec. 291c(e); and 42 CFR, sec. 124.603.
20. HHS Office for Civil Rights, "Fact Sheet: Your Rights under the Community Service Assurance Provision of the Hill-Burton Act," http://www.hhs.gov/ocr/hburton.pdf (accessed 15 August 2007).
21. This section is based on J. Perkins, M. Youdelman, and D. Wong, "Summary of State Law Requirements Addressing Language Needs in Health Care," http://www.healthlaw.org/library/item.174993- Summary_of_State_Law_Requirements_Addressing_Language_Needs_in_Health_Care. For methodology, see the online technical appendix at http://content.healthaffairs. org/cgi/content/full/27/2/424/DC1.
22. California Government Code, secs. 11135 and 11139.
23. Ibid., secs. 7290-7299.8.
24. California Health and Safety Code, sec. 1367.04;
25. California Insurance Code, sec. 10133.8;
26. and California Code of Regulations, title 28, secs. 1300.67.04 and 1367.07.
27. Annotated Code of Maryland, State Government Article, secs. 10-1101-10-1105.
28. District of Columbia Official Code, 2001 Edition, secs. 2-1931-2-1935.
29. New Jersey Revised Statutes C.45:9-7.2-7.4;
30. California Business and Professional Code, sec. 2190.1;
31. and Revised Code of Washington, sec. 43.70.615.
32. These states are Arizona, Colorado, Georgia, Illinois, Maryland, New Mexico, New York, and Ohio. See D. Graves et al., "Legislation as Intervention: A Survey of Cultural Competence Policy in Health Care," Journal of Health Care Law and Policy 10, no. 2 (2007): 339.
33. State of Rhode Island General Laws, sec. 231754.
34. Colorado Code of Regulations 6, sec. 1011-1, Chap. V - Long Term Care Facilities (12.1.6(4), 12.1.10).
35. Illinois Administrative Code, title 59, secs. 111.25(4)-(5).
36. Illinois Compiled Statutes, chap. 405, sec. 75/0.01-75/1.
37. Some states have both types; five have general provisions but none on abortion or sterilization.
38. 20 U.S. Code, sec. 1439(a)(7).
39. 42 U.S. Code, sec. 3002(24).
40. G. Flores et al., "Errors in Medical Interpretation and Their Potential Clinical Consequences in Pediatric Encounters," Pediatrics 111, no. 1 (2003): 6-14.
41. See, generally, J. McQuillan and L. Tse, "Child Language Brokering in Linguistic Minority Communities: Effects on Cultural Interaction, Cognition, and Literacy," Language and Education 9, no. 3 (1995): 195-215.
42. State of Rhode Island General Laws, sec. 231754;
43. and Code of Massachusetts Regulations, title 105, sec. 130.1105(D).
44. See National Council on Interpreting in Health Care, "A National Code of Ethics for Interpreters in Health Care," July 2004, http://www.ncihc.org/sop.php (accessed 30 November 2007).
45. Washington Administrative Code, secs. 388-03-010-03-176.
46. See ProEnglish, "English in the Fifty States," http://www.proenglish.org/issues/offeng/states.html (accessed 15 November 2007).
47. Alabama, Arizona, Georgia, Idaho, Iowa, Kansas, Utah, and Wyoming.
48. E. Martinez, S. Hitov, and M. Youdelman, Language Access in Health Care Statement of Principles: Explanatory Guide, November 2007, http://www.healthlaw.org/library/item.121215- Language_Access_in_Health_Care_Statement_of_Principles_Explanatory_Guide_Oc (accessed 2 January 2008).
49. M. Youdelman, "Medicaid and SCHIP Reimbursement Models for Language Services: 2007 Update," May 2007, http://www.healthlaw.org/library.cfm?fa= download&resourceID=102451&print (accessed 3 December 2007).
50. For example, the Speaking Together National Language Services Network program focuses on quality improvement strategies for hospitals' language services. See http://www.speakingtogether.org.