[lg policy] California: Breaking Language Barriers in Health Care

Harold Schiffman hfsclpp at GMAIL.COM
Wed Sep 16 15:19:05 UTC 2009

Breaking Language Barriers in Health Care

California Program on Access to Care

For someone with limited English, using typed medication directions
instead of hand written directions can make a huge difference in
understanding medical instructions.
Approximately 6 to 7 million Californians--20 percent--have limited
English proficiency (LEP), meaning these individuals cannot speak
English well or cannot speak English at all.
In San Francisco, Los Angeles, Monterey, and Imperial counties the
numbers are even greater—25 percent to 33 percent of the population
has limited English proficiency.
Language barriers often result in health care barriers. Research shows
that language barriers contribute to inadequate patient evaluation and
diagnosis, lack of appropriate and/or timely treatment, and other
medical errors that compromise the safety of patients who have limited
English skills and result in increased medical costs.

In California, all private and public health plans are required to
provide language services if they have certain levels of enrollees who
are not English proficient. Therefore, efficiently allocating language
resources becomes a matter of economic imperative. The California
Program on Access to Care (CPAC), part of UC Berkeley’s School of
Public Health, recently funded a study entitled California’s Limited
English Proficient Population (LEP) and Strategies to Promote Health
Care Access. The study’s authors, UC Berkeley researchers Mary Masland
and Lonnie Snowden, identified California’s various limited English
proficient groups by language and birth country. They then assessed
health care difficulties and evaluated strategies to increase health
care understanding for LEP groups.

The study found that using language resources effectively for
education outreach and patient-doctor communication can make a real
difference in health care outcomes for limited English proficient
groups. For example, when the study looked at preventive care, it
revealed large numbers of Asian language women forgoing cervical
cancer screening. In contrast, nearly all Spanish language women were
current with cervical screenings, driven in large part to previous
research that called for public health outreach within
Spanish-speaking communities and the expanded role of of
Spanish-speaking clinics where screenings can be performed
conveniently and affordably.

The study’s recommendations for making the most of language resources include:

• Using video interpretation pools so that the state’s relatively few
professional health care interpreters can help patients with limited
English skills who live in remote locations,
• Using typed instructions, which are easier for limited English
proficient persons whose native language does not use a Roman
• Having a bilingual nurse, ad-hoc staff, or family member review
pharmacy and doctor instructions with the patient before leaving a
doctor’s office,
• Ensuring written materials are compatible with the very low
educational level of some limited English proficient groups, and
• Employing the appropriate media for health education outreach to
limited English proficient populations--media such as phone, radio,
video or TV, brochures or local newspapers are preferred since most
LEP groups do not have access to the Internet.

According to research, the cost of providing effective language
services may be recouped through reduced testing, shorter visits, and
improved patient compliance. The recommendations from this study can
help private and public health providers effectively use language
resources to create a win-win situation for both patients and health
care providers.”

The California Program on Access to Care is an applied policy research
program administered by UC Berkeley School of Public Health in
coordination with University of California Office of the President.
CPAC works to expand health care access for the state’s most
vulnerable populations, including immigrants, agriculture workers, the
working poor, and other low-income groups. For more information about
this study and other CPAC-sponsored studies, visit:

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