Limited Health Care for Limited English Speakers in California

by Translation Guy on March 12, 2013

It’s the sickest patients who have the hardest time communicating with their doctors, according to a recent study from UCLA Center for Health Policy Research. Californians with limited English skills report the poorest health and were more likely to have problems understanding their doctors.

Almost one out of eight HMO members in California is considered to speak and understand English with limited proficiency (LEP). That’s about 1.3 million people. This is the same group that reports having the most trouble communicating with their doctors.

That problem will likely worsen quickly as LEP speakers make up over a third of California’s newly insured population after the implementation of President Obama’s Affordable Car Act.

“The sickest people are having the hardest time talking to their doctors,” said Max Hadler, a research associate at the Center for Health Policy Research and the main analyst for the study. “If a patient can’t communicate, how can their doctor treat them effectively? Appropriate interpreter services and translated materials are a consumer right and key to providing high-quality care and reining in the growth in health care costs.”

While current regulations require health care plans to provide care in Spanish, the degree of actual compliance remains unclear. Some data suggests that many medical providers continue to rely on amateurs such as family members and untrained staff to supply interpretation services. Almost half of all LEP enrollees in California report receiving assistance from these non-professionals.

Every time this occurs, it means that patients are denied access to healthcare through denial of the basic principles of the translator’s trade. That code of ethics, the guarantee of confidentiality, tested proficiency in source and target language, health literacy, terminology training, all those essentials are denied to patients in violation of the law.

There is a “lack of consistent training of interpreters” and interpreting best practice makes for a big difference in outcome, says Dylan Robie, lead investigator.

Healthcare givers often weight the value of translation against its cost in scare resources. Reluctance to use professionals is often because decision-makers underestimate the life-threatening danger of bad translation for the same reason that the amateur interpreters fail: Lack of experience and training.


  1. Mr. Thug says:

    If a patient can’t communicate how can they be treated? Shouldn’t medicine have advanced enough that doctors would have the training and technology to mitigate this issue?

    • Ken says:

      I sometimes think that the training of physicians discourages them to use interpreters. I’ve written on this a bit and will write more.

  2. Everytime I turn on my computer or smartphone for news, the headlines pretty much read: Everything Awful, Oh God someone do something.

  3. What is the solution though, yes lack of experience and training, but does the industry need a centralized set of standards and how would you administrate that kind of thing?

  4. Lee says:

    Obama should have foreseen this and provided for it, if better healthcare was really his aim.

  5. Shouldn’t California, with such a massive Hispanic population, have more people that can speak and translate Spanish and ensure this isn’t such a problem?

  6. Aditya Gupta says:

    It’s a shame something as conquerable as a language barrier is costing people their health, and possibly their lives as well in a country as rich as the United States.

  7. Kelly Vitt says:

    Even if the situation could be fixed, I bet the insurance companies would somehow manage to stick it to the paitent even more.

  8. OJ Thornton says:

    What would you suggest as a remedy for this situation? Hospitals and insurance companies are certainly reluctant to spend the money necessary for good interpreters to be everywhere, and even if they did, the cost would be passed on to patients.

    • Ken says:

      It depends on the metric, I guess. If the metric is saving lives, then translators win. If the metric is saving money, then translators lose. That makes it sound easier than it is, I guess.

  9. You raise an interesting point, I speak Spanish and English pretty fluently, but if I were to be in a situation where I had to interpret for a doctor, a lot of the technical/medical stuff I would have no idea how to translate.

  10. Maybe growing publicity for this issue, will ensure that more and better interpreters getting trained and hired, although with the financial climate that is probably a pipe dream.

  11. This is one of the reasons healthcare in this country scares the bejesus out of me, we are the so called greatest country on earth on can’t manage to ensure people get quality care due to something as simple as a language barrier.

  12. lori says:

    The problem is the fiscal climate, there just isn’t the room on the balance sheet to provide the service unless patients take on the cost themselves and healthcare is already incredibly costly.

  13. Good article, a really overlooked issue and something that is only going to become more of a problem without attention.

  14. Silvia says:

    This is why Obamacare while in theory is a good idea, in practuce it is a bondoggle.

    • Ken says:

      Stay tuned. I’ve got more.

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