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Facing any kind of health challenge can be scary, not to mention confusing. Understanding the terminology surrounding a medical condition may feel like learning a second language — and that’s if you already speak the language your diagnosis is delivered in. Even before reaching that point, those in the United States who do not speak English as their primary language are at a disadvantage.
Across the country, around 1 in 10 working adults has limited proficiency in English. In Massachusetts alone, nearly a quarter of the population speaks a language other than English as their primary language at home, with some areas up to 70%. Spanish is the most commonly spoken non-English language in the state, followed by Portuguese. When patients experience language barriers while figuring out where to go for care, finding the right doctor, and navigating costs, inequities can start to occur. To help ensure everyone has equal access to quality care, medical interpreters are essential for communication with non-English speaking patients.
“We don’t want people not seeking care because they can’t communicate or they fear the system because then we’ll have a public health crisis, which is already a concern when we think about COVID,” says Lisa Morris, director of Cross Cultural Initiatives at UMass Medical School.
Lost in translation
When non-English speakers need to seek care, there is often a gap in understanding how the American health system works; it can be challenging to know what type of facility or provider to visit. As a result, these patients often see the emergency room as the easiest and most direct solution, when the health issue may be better addressed in a non-emergent setting.
“Not providing language services to a patient disables them because the patient doesn’t have the tools to navigate the system.”
— Lisa Morris, director of Cross Cultural Initiatives, UMass Medical School
Morris shares an analogy to help explain the significance: “If a patient comes to see a doctor and their wheelchair is broken, they’re not getting around very functionally. Not providing a new wheelchair to that patient disables them,” says Morris. “Not providing language services to a patient disables them because the patient doesn’t have the tools to navigate the system.”
While many hospitals and health care providers are bolstering their translation services, there is still progress to be made. In many areas, professional interpretation is hard to come by due to high costs and poor availability. Because of this, some providers are turning to language interpretation tools and other lower-cost approaches, with mobile software being one example. Online translation tools such as Google Translate and MediBabble in hospitals have led to higher patient satisfaction. While useful options, these services are not a total replacement for encounters with professional medical interpreters. “[Providers] need to be more accepting of waiting for a qualified interpreter, whether it takes 90 seconds or 5 minutes,” urges Morris. “Not taking that time can be a much higher cost to the system as a whole.”
Closing the gap by growing the workforce
With interpretation needs, the key isn’t just simple translation of medical terms — it’s also helping non-English speaking individuals understand nuanced health insurance benefits and coverage in their preferred language.
“As a native Spanish speaker, if you put me on the phone to talk to my mother about co-insurance, co-pay, deductibles, I’m at a loss for Spanish words because of the complexity,” explains Juan Fernando Lopera, former VP marketing & RI Medicaid, public plans; business diversity officer, now at Beth Israel Lahey Health. “While someone may be bilingual, they really need the tools and skills to provide the right language and service to members in a way that’s the highest quality with the right cultural competence,” says Lopera.
Beyond communicating with the right terms, interpreters must also understand the cultural norms and needs of a population. These considerations are built into the Multicultural Service Program at Tufts, the result of a partnership with Bunker Hill Community College. This program trains Spanish-speaking call center representatives on health insurance literacy, helping reps communicate health plans with almost 80,000 Latinx members.
Morris stresses how sponsored training programs like these are essential. “We need to encourage payer systems to support medical interpreter training programs so there’s a larger workforce,” she explains. “Right now, there’s a deficit, especially in qualified medical interpreters.”
“While someone may be bilingual, they really need the tools and skills to provide the right language and service to members in a way that’s the highest quality with the right cultural competence.”
— Juan Fernando Lopera, former VP marketing & RI Medicaid, public plans; business diversity officer, now at Beth Israel Lahey Health
Harvard Pilgrim Health Care offers free language interpretation services to its members in more than 120 languages. Deaf and hard-of-hearing members who have access to a Teletypewriter (TTY) can communicate directly with the Member Services Department by calling the plan’s TTY machine — an important tool, given that more than 37.5 million American adults have some difficulty hearing.
More conversations ahead
Moving forward, improving and expanding language services will be crucial in order to combat disparities in health care, as well as partnering with community-based organizations. Community workers often have a closer, more established relationship with the neighborhoods they serve, and their proximity helps non-English speakers who live within the neighborhoods access interpretation services.
One example is the Dimock Center, who throughout its long history in Massachusetts has offered free health services, translated resources, and more. Many of the providers and staff live within the same neighborhoods as the patients they care for. For 65% of the residents the Dimock Center serves, English is not their first language.
East Boston Neighborhood Health Center, another community partner in health outreach, offers services in 250 different languages and receives around 170,000 interpreting requests a year.
“Most interpretations used to be done on a face-to-face basis, but that was changed eight years ago,” says Elida Acuna-Martinez, director of Interpreter Services. “That helped us become more efficient and more productive, and during the pandemic, we were ahead of the curve. We’re part of the culture, the community, and we know what it’s like. People like us need to be in conversations with providers.”
These barriers in communication will take time to overcome, but with increased investment in interpretation tools and programs, providers and insurers can help ensure everyone has equal access to health care, regardless of their language.
“It’s about human connection,” explains Brett Phillips, chief of staff at East Boston Neighborhood Health Center. “Medical care can sometimes be anxiety-inducing, so having that personal touch in the language you speak is huge.”
Updated November 2022:
Point32Health health plans Harvard Pilgrim Health Care and Tufts Health Plan are the first in New England and among the first nationally to achieve full NCQA Health Equity Accreditation. Learn more about our commitment to reducing disparities and improving care so all we serve can reach their full health potential: read the press release.