HMOs Confront Language Struggles

A new study by UCLA researchers has discovered a link between low levels of English proficiency among health plan enrollees and difficulty in accessing healthcare.

According to the study, which was undertaken by the UCLA Center for Health Policy Research, as many as 1.3 million Californians with limited proficiency in the English language are enrolled in health maintenance organizations. Most are enrolled in plans that are designed to serve low-income enrollees, although nearly 10% are enrolled in commercial plans.

About 12% of those enrollees – most of whom spoke Spanish as their primary language – said they had trouble communicating with their physicians.

Despite state laws and regulations regarding provisions for interpretative services for these enrollees, about half of those surveyed said they did not receive them.

“One of the problems with planning for and providing effective interpreter services for our LEP population in California is the lack of consistent training of interpreters,” said Dylan Roby, lead investigator on the study and director of the Center's Health Economics and Evaluation Research Program. “Although health plans are required to assess the language needs of their members and develop a plan to address them, there is quite a bit of variation in how they do so and who is expected to provide interpretation to patients at the bedside or during a visit.”

The study also suggested that there was a “disconnect” between the expectations of health plans in dealing with language barrier issues and the actual reality confronted by their enrollees.

The study showed significant gender and ethnic divisions when it came to language issues: About two-thirds of females said they had a hard time understanding their physicians, versus about one-third of males.

Enrollees in commercial health plans were more likely to have communication issues than those in public plans, while Asians and Pacific Islanders had communication issues less than 20% of the time.

Income divisions ran across similar lines: About two-thirds of those with incomes below 200% of the federal poverty level said they had trouble communicating. Only about one-third of respondents with incomes above that threshold said they had trouble communicating with their doctors.

Given that as much as 36% of those Californians who receive healthcare coverage next year as a result of the Affordable Care Act, the study's authors suggested that health plans exercise more rigor in training bilingual staff and contracting for language interpretation services.