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Disparities/Minority Health

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Studies highlight the importance of providing interpreter and translating services for minorities

In 2000, nearly 18 percent of Americans spoke a language other than English at home, and physicians are caring for more patients who are limited in their ability to speak English. A new study supported by the Agency for Healthcare Research and Quality (HS11305) makes the case that by paying for interpreters now for patients who find it difficult to understand and speak English, insurers will save care costs later. A second AHRQ-supported study (HS10637) examines the problems encountered by Navajo interpreters in translating the standard research consent form for Navajo people with diabetes. Both studies are briefly discussed here.

Ku, L., and Flores, G. (2005, March). "Pay now or pay later: Providing interpreter services in health care." Health Affairs 24(2), pp. 435-444.

Federal civil rights policy obligates health care providers to supply language services to patients who can't speak English. However, Medicare and most private insurers do not pay for interpreters, and only 10 States pay for interpreters under Medicaid. The authors of this paper indicate that insurers may end up paying a lot more for extra tests and procedures to diagnose health problems, preventable hospitalizations, medical errors and injuries, and expensive lawsuits when interpreters are not provided for patients who speak limited English.

The authors point out that language barriers can lead to inefficient care because clinicians are unable to elicit symptoms from patients with limited English speaking skills. As such, they may use more diagnostic resources or invasive procedures. Also, family interpreters are more likely than professional interpreters to commit errors that have potential clinical consequences. In contrast, patients who are provided with professional interpreters make more outpatient visits, receive and fill more prescriptions, and do not differ from English-proficient patients in test costs.

In 2002, the U.S. Office of Management and Budget estimated that interpretation costs an average of $4.00 per patient visit or 0.5 percent of the total visit cost. This is far less than the large disparities in medical spending that exist between white patients and Latino and Asian patients. Paying for language services may help reduce the existing racial/ethnic disparities in health care, conclude the authors.

McCabe, M., Morgan, F., Curley, H., and others (2005, Spring). "The informed consent process in a cross-cultural setting: Is the process achieving the intended result?" Ethnicity & Disease 15, pp. 300-304.

This report describes the problems Navajo interpreters encountered when translating the standard research consent form for Navajo Indians participating in a diabetes clinical trial. Several interpreters and a Navajo language consultant developed a translation of the standard consent form. They maintained the sequence of information and exactly translated English words and phrases, but they often were unable to translate specific wording required by the Institutional Review Boards into something comprehensible in Navajo.

They found that the consent process often led to embarrassment, confusion, and misperceptions. For instance, potential Navajo participants felt that repeatedly discussing telephone communication was irrelevant when many did not have telephones. Also, areas of contradiction raised issues of mistrust. For example, information about lack of compensation for injuries that might result from participating in the clinical trial seemed to contradict previous assertions that serious adverse effects were unlikely to occur.

To make consent forms more understandable to minority populations, the researchers suggest reducing strict legal and scientific jargon. They also recommend identifying and altering, when possible, standard consent form language that may engender mistrust. In addition, researchers suggest re-sequencing the form to facilitate logical translations into complex languages. Finally, those administering consent forms should be culturally competent to address questions and potential misunderstandings by people who participate in clinical trials.

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