Full Report – Hospital Language Services for Patients with Limited English Proficiency

Executive Summary

A national survey of hospitals to examine their policies and practices for providing language services to limited English proficient (LEP) patients.

The development of this report was funded by The California Endowment.
We would like to thank Steve Hitov and Mara Youdelman of the National Health Law Program and Ellen Pryga of the American Hospital Association for their substantial and detailed comments on the development on all aspects of this report.
©October 2006 by the Health Research and Educational Trust


Executive Summary

Health care providers from across the country have reported language difficulties and inadequate funding of language services to be major barriers to limited English proficiency (LEP) individuals? access to quality health care.Almost 52 million people?over 19% of the U.S. population?speak  a language other than English at home.The Census Bureau?s 2005 American Community Survey documented that over 29% of all Spanish speakers, 22% of Asian and Pacific Island language speakers, and 13% of Indo-European language speakers speak English ?not well? or ?not at all.? Estimates of the number of people with LEP range from a low of about 12 million, or 4.5% of the U.S. population?who speak English ?not well? or ?not at all??to over 23 million people, or 8.6% of the U.S. population?if one includes those who speak English less than ?very well.?
The Health Research and Educational Trust (HRET), the research and educational affiliate of the American Hospital Association, in collaboration with the National Health Law Program, conducted a national survey of hospitals in the United States to seek information about patient language services in hospitals.The purpose of the survey was to better understand the processes and resources available to hospitals in providing language services to patients with LEP.
This report describes current practices, common barriers, and the specific resources and tools needed to provide language services to patients with LEP.The results of the survey will inform federal policymakers, practitioners, providers, and others of the issues and potential solutions facing hospitals as they work to improve language services for all patients with LEP.
Key Findings
  • 63% of hospitals encountered patients with LEP either daily or weekly; an additional 17% encountered LEP patients at least monthly.
  • Hospitals used a wide variety of sources to assess the language needs of communities including using census data and collecting language information directly from patients.
  • The most common approach for creating polices and procedures to provide language services was through hospital management.
  • 82% of hospitals indicated that staff interpreters were the most frequently used resource for providing language services.
  • 92% of hospitals indicated that telephonic services were the most available resource for providing language services.
  • 88% of hospitals reported providing language services during off-hours.
  • 3% of hospitals indicated receiving direct reimbursement for providing language services.
  • Of the 3% of hospitals that received direct reimbursement, 78% indicated receiving reimbursement from Medicaid.
  • The most frequent barrier hospitals faced in providing language services was that staff had no means of identifying patients who needed language services before they arrived at the hospital.
  • Tools that hospital staff would find useful for providing language services included packaged in-service training programs and model approaches and promising practices demonstrated by other health care institutions serving LEP patients.
  • Training that hospital staff would find most useful for providing language services included how to respond to patients and family members who did not speak English and cultural competency training.
  • 33% of hospitals were engaged in initiatives to improve language services, and 72% of those engaged indicated that they would be willing to share information about their initiatives.
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