ACA rule boosted medical interpreter access, health equity

The number of patients with limited English proficiency getting access to medical interpreters increased nearly threefold between 2011 and 2023, an indication that Affordable Care Act provisions requiring access to interpreters was effective, researchers wrote in a JAMA Network Open report.

The study, which was based on nearly 6 million survey responses across a 13-year period, specifically investigated the effects of Section 1557 of the Affordable Care Act (ACA). Among other things, this provision explicitly requires the use of qualified interpreters and translators and prohibits use of untrained individuals for interpretation, such as family members.

Per figures from the University of Pennsylvania's Leonard Davis Institute of Health Economics, nearly 25 million people in the United States have limited English proficiency (LEP).

Coupled with dismal health literacy rates across all language preferences, this makes for a perfect storm in healthcare. Folks with limited English proficiency might struggle to understand or engage with their care if they cannot meet with a provider who speaks the same language or have access to a qualified medical interpreter.

But too often, hospitals and health systems can't provide those interpreters, particularly given resource constraints. In these cases, hospitals will often rely on bilingual, non-clinical staff or even family members to interpret for patients. Those situations increase the risk of miscommunication, experts contend.

The ACA's mandate for using medical interpreters was a key step forward in ensuring health equity, the researchers found.

The researchers examined how California Health Interview Survey respondents answered the question "who helped you understand your doctor?" to assess the impacts of the 2016.

Overall, the mandate worked, they found. Between 2011 and 2023, the number of patients using professional interpreters to understand their doctors rose from 8.3% to 34.9%.

Still, there is room to grow, the researchers said. For one thing, it'd be optimal for all patients who speak a language other than English to have access to professional medical interpreters. At present, fewer than half do, despite the strides taken in the past decade.

Moreover, the researchers found it's still common for patients to get help from someone who is not a medical interpreter. Across the entire 13 years' worth of data, the researchers found that assistance from medical staff was the most common way LEP patients were able to understand their doctors.

Consulting bilingual medical staff is better than using family members for interpretation, but considering the extreme workloads all providers face, this figure indicates a need for more bilingual doctors or more medical interpreters.

That said, it was rare for patients to use any less-than-ideal methods for understanding their doctors.

Only about 1% of respondents said they've used a minor child as an interpreter across the entire 13 years' worth of survey data. Another 1.5% said they used "other means," meaning looping in other patients, and 1.9% said they received no assistance. That notwithstanding, the researchers said these methods need to be totally avoided to ensure no medical errors or ethical concerns arise.

"While the [analysis] showed no significant difference in the use of adult family members or friends as ad hoc interpreters, these individuals' persistent involvement raises important concerns given the associated risks of communication errors," the researchers concluded.

"Similarly, frequent use of medical and nonmedical staff underscores the need to certify bilingual staff to minimize interpretation inaccuracies. The persistent use of children in interpreter roles, while rare, raises ethical concerns."

Sara Heath has reported news related to patient engagement and health equity since 2015.