Study links language barriers to much lower access to health care

Health workers work on mobile medical units in the hallway of the temporary COVID-19 ICU at Northeast Georgia Medical Center (NGMC) in Gainesville on Wednesday, Jan. 20, 2021, during a particularly deadly period of the COVID-19 battle. (Hyosub Shin / Hyosub.Shin@ajc.com)
Caption
Health workers work on mobile medical units in the hallway of the temporary COVID-19 ICU at Northeast Georgia Medical Center (NGMC) in Gainesville on Wednesday, Jan. 20, 2021, during a particularly deadly period of the COVID-19 battle. (Hyosub Shin / Hyosub.Shin@ajc.com)

Credit: HYOSUB SHIN / AJC

Credit: HYOSUB SHIN / AJC

Language barriers significantly limit access to health care for U.S. residents with limited English proficiency — a population of over 25 million people nationwide, including more than 500,000 in Georgia.

That’s the main takeaway from a new study published Tuesday in Health Affairs, a leading health policy research journal.

According to the study’s authors, a group of researchers from Harvard Medical School and the City University of New York’s Hunter College, Spanish speakers receive approximately one-third less care than other Americans, even with differences in baseline health, age, income and health insurance taken into account. While there have been multiple policy initiatives at the federal level aimed at strengthening language services in hospitals and clinics, the study indicates these might have had limited effectiveness: Key language-based disparities in health care access have only grown over the past two decades.

Researchers estimated the care deficit of non-English speakers by comparing health care-related metrics for Spanish-speaking adults with those of their English-speaking counterparts, using federal survey data from over 120,000 U.S. residents, covering the period of time from 1999 to 2018. Ultimately, researchers found that total use of care — as measured by health care expenses — was up to 42% lower for primary Spanish speakers.

In addition, Spanish-speaking adults registered 36% fewer outpatient visits and 48% fewer prescription medications than non-Hispanic adults, as well as fewer emergency room visits and hospitalizations (similar gaps were observed between Spanish speakers and Hispanic adults who were proficient in English).

“The gaps in care that we observed could be a result of several factors rooted in language-based inequities. Non-English speakers may be less likely to seek care for health concerns, anticipating that their needs might not be met,” researchers wrote. “Patients with limited English proficiency, for example, may have had prior negative experiences with the health care system, including being made to feel unwelcome or discriminated against.”

The study looked at data for Spanish speakers and extrapolated it to adults with limited English proficiency.

Publication of the study comes amid an ongoing pandemic that continues to take a disproportionate toll on racial and ethnic minority groups. Language barriers could be exacerbating that toll.

“The pandemic has been a magnifier of the failure of our health care system to meet the needs of patients facing language barriers,” said the study’s lead author, Dr. Jessica Himmelstein, a Harvard research fellow and primary care physician at Cambridge Health Alliance.

ExploreOPINION: Making sure language doesn’t get in the way of health care

Lautaro Grinspan is a Report for America corps member covering metro Atlanta’s immigrant communities.

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