Report on Research Project -Access through Medical Interpreter and Language Services

Background:

This study was conducted by the New York Task Force on Immigrant Health, New York University School of Medicine, Division of Primary Care. The ultimate goal of the project was to create a comprehensive medical interpreter network in New York City. To accomplish this the project first conducted an analysis of established medical interpreter programs across the country. In the fall of 1995, site visits were conducted in: California, Illinois, Massachusetts, and Minnesota. Telephone interviews were conducted in Florida and Washington State. In addition a language needs assessment of New York City health care facilities was conducted.

Established Medical Interpreter Programs:

This project first analyzed established medical interpreter programs to identify the best features of each and to determine the feasibility of replicating these features. The factors assessed were:

the linguistic needs of patients;
the position of the hospital administrations toward language services;
current strategies to address the language needs of patients;
the organization of interpreter services within the facilities;
the methods of screening and training interpreters; and
the methods of financing interpreter services.

Some of the problems addressed were:

the difficulty enforcing linguistic access requirements;
the fact that few beneficiaries are aware of their right to an interpreter or empowered enough to demand one; and
the lack of funds.

Impact of Managed Care:

The project also assessed the impact that managed care might have on linguistic access to health care. Concerns raised included:

the complexity of the enrollment process will not be grasped by the beneficiaries;
the lack of staff with language and cultural competency in managed care facilities will lead to inadequate services; and
managed care's emphasis on cost efficiency will obstruct investment in extra services needed (education and interpretation).

The objective should be to ensure that language appropriate services are available at all points of managed care service delivery. With new managed care laws states could add language access requirements into their managed care contracts.

Developing an Interpreter Program:

The research found that motivation to develop an interpreter program is often shaped by:

pressure from physicians;
a desire to gain a larger share of the market through increased patient volume;
the threat of malpractice law suits;
a response to the influx of refugees and immigrants; and
the fact that providing in-person interpreter services is more cost-effective than telephone interpreter services.

There are a broad range of approaches to meet the needs of a multi-lingual patient population. Common components include:

hiring bilingual providers;
volunteer or paid staff interpreters (full or part-time);
part-time freelance interpreters;
regionally based interpreter pool;
contract with a community-based organization; and
reliance on a hospital language bank and/or volunteer program.

Of these options, hiring bilingual providers is the preferred approach in terms of safety and cost-efficiency. The least cost-effective method is a commercial telephone interpreter service or language bank such as that run by AT@T.

Training/Screening Interpreters:

Interpreting and interpreters need to be taken more seriously. They are often under utilized and under publicized. In the training and screening of interpreters, the following characteristics should be noted:

bilingualism;
culturalism (awareness of cultural beliefs);
interpersonal skills; and
adherence to a code of ethics (mostly confidentiality).

Any trainer in this area should be a person who has actually translated in a health care setting, has a solid grasp of techniques needed for effective interpreting, and be an effective teacher.

Trends:

Emerging trends are:

the development of standards for interpreters; and
certification.

Regarding cost arrangements, the trends are:

hospital financed;
medicaid reimbursement; and
managed care cost absorption.

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