California: State agencies address language barrier

Harold F. Schiffman haroldfs at
Wed May 17 12:51:34 UTC 2006


State agencies address language barrier

By Natalie Banach
nbanach at

State health care agencies are on the move after UCLA public health
researchers released a study last week revealing that more than 1 million
adults in California face restricted health care access because they do
not speak English proficiently. The study by the UCLA Center for Health
Policy Research disclosed that those with limited English proficiency are
more likely to have problems accessing health care services, and health
care providers whether public or commercial are not doing enough to ensure
quality treatment. For state agencies, the news underlines the importance
of certain changes already being made.

The Department of Managed Health Care is currently putting together a set
of standards for language service access and is also working to get
private health care providers on par with their public school
counterparts. More than 300,000 Californians enrolled in commercial Health
Maintenance Organization plans report having trouble understanding their
physicians, and 5 percent of these individuals say they were not able to
find translators to help them, according to the study. "There is not a lot
of information about language services. ... We were able to make
comparisons across HMOs. That's what is unique," said Gerald Kominski,
associate director of the UCLA Center for Health Policy Research and the
lead author of the study.

Previous studies regarding the language barrier did not ask respondents
about their specific health care providers and the type of service they
received, Kominski added. The UCLA policy brief has provided information
for the California Department of Managed Health Care, the California
Office of the Patient Advocate and state legislators, which reinforces the
need to address issues associated with the language barrier. "We know that
language barriers affect quality. What we didn't know was exactly how many
enrollees we're talking about," said Ed Mendoza, acting director of the
California Office of the Patient Advocate.

Understanding one's health care plan and the complex issues surrounding
diagnoses and treatment can be difficult even for those proficient in
English, "so you can imagine how much more difficult it is for those who
have limited English proficiency," Mendoza added. The different types of
problems limited English-speaking HMO enrollees run into include
miscommunication with their physician and an inability to efficiently deal
with their health care providers. In fact, one study found that over 25
percent of non-English-speaking patients could not understand their
prescription instructions, according to the policy brief.

The study also found that public Medi-Cal and Healthy Families plans have
for the most part done a better job of allocating language services to
members with limited English proficiency. The immediate goal of state
agencies and legislators is to regulate commercial HMO plans to mimic
their public counterparts in language service access, public health
officials said. State agencies are already on their way to making
improvements to the system, and the study has worked to emphasize the
needs for such changes, Kominski said. The Department of Managed Health
Care responsible for managing HMOs is in the process of regulating the
standards concerning language access for commercial plans.

In addition, state legislators are considering setting up a task force to
find out how health care providers can be reimbursed for providing
language services to their subscribers, Mendoza said. In addition to the
need for an increase in the number of translators and interpretation
services, solutions include offering written and verbal information about
various HMO plans and medications. Spanish and Chinese are the most
predominant languages spoken in California other than English, and Mendoza
said he would like to see these and about 12 to 14 other languages
covered. Ninety-three percent of health care plans report having a
Spanish-speaking interpreter available during business hours, the UCLA
study found. "Now that we have a better idea of how many enrollees need
language services, we'd like to see regulations adopted," Mendoza said.

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