What do language barriers cost? An exploratory study among asylum seekers in Switzerland

Alexander Bischoff, Kris Denhaerynck, Alexander Bischoff, Kris Denhaerynck

Abstract

Background: Language barriers have a major impact on both the quality and the costs of health care. While there is a growing body of evidence demonstrating the detrimental effects of language barriers on the quality of health care provision, less is known about their impact on costs. This purpose of this study was to investigate the association between language barriers and the costs of health care.

Methods: The data source was a representative set of asylum seekers whose health care was provided by a Swiss Health Maintenance Organisation (HMO). A cross-sectional survey was conducted: data was collected on all the asylum seekers' health care costs including consultations, diagnostic examinations, medical interventions, stays in the clinic, medication, and interpreter services. The data were analysed using path analysis.

Results: Asylum seekers showed higher health care costs if there were language barriers between them and the health professionals. Most of these increased costs were attributable to those patients who received interpreter services: they used more health care services and more material. However, these patients also had a lower number of visits to the HMO than patients who faced language barriers but did not receive interpreter services.

Conclusion: Language barriers impact health care costs. In line with the limited literature, the results of this study seem to show that interpreter services lead to more targeted health care, concentrating higher health care utilisation into a smaller number of visits. Although the initial costs are higher, it can be posited that the use of interpreter services prevents the escalation of long-term costs. A future study specially designed to examine this presumption is needed.

Figures

Figure 1
Figure 1
Theoretical framework used in the path analysis.

References

    1. Castles S, Miller MJ. The age of migration: international population movements in the modern world. Houndmills [etc.]: MacMillan; 1993.
    1. Messias DKH, McDowell L, Estrada RD. Language Interpreting as Social Justice Work: Perspectives of Formal and Informal Healthcare Interpreters. Advances in Nursing Science. 2009;32(2):128–143. 110.1097/ANS.1090b1013e3181a1093af1097.
    1. Ou L, Chen J, Hillman K. Health services utilisation disparities between English speaking and non-English speaking background Australian infants. BMC Public Health. 2010;10:182. doi: 10.1186/1471-2458-10-182.
    1. Fiscella K, Franks P, Doescher MP, Saver BG. Disparities in health care by race, ethnicity, and language among the insured: findings from a national sample. Med Care. 2002;40(1):52–59. doi: 10.1097/00005650-200201000-00007.
    1. Flores G, Laws MB, Mayo SJ, Zuckerman B, Abreu M, Medina L, Hardt EJ. Errors in medical interpretation and their potential clinical consequences in pediatric encounters. Pediatrics. 2003;111(1):6–14. doi: 10.1542/peds.111.1.6.
    1. Divi C, Koss RG, Schmaltz SP, Loeb JM. Language proficiency and adverse events in US hospitals: a pilot study. Int J Qual Health Care. 2007;19(2):60–67. doi: 10.1093/intqhc/mzl069.
    1. Derose KP, Baker DW. Limited English proficiency and Latinos' use of physician services. Med Care Res Rev. 2000;57(1):76–91. doi: 10.1177/107755870005700105.
    1. Rivadeneyra R, Elderkin-Thompson V, Silver RC, Waitzkin H. Patient centeredness in medical encounters requiring an interpreter. Am J Med. 2000;108(6):470–474. doi: 10.1016/S0002-9343(99)00445-3.
    1. Carrasquillo O, Orav EJ, Brennan TA, Burstin HR. Impact of language barriers on patient satisfaction in an emergency department. J Gen Intern Med. 1999;14(2):82–87. doi: 10.1046/j.1525-1497.1999.00293.x.
    1. Hampers LC, McNulty JE. Professional interpreters and bilingual physicians in a pediatric emergency department: effect on resource utilization. Archives of Pediatrics & Adolescent Medicine. 2002;156(11):1108–1113.
    1. Smedley BD, Stith AY, Nelson AR. Unequal treatment. Confronting racial and ethnic disparities in health care. Washington: The National Academies Press; 2003.
    1. Cohen AL, Rivara F, Marcuse EK, McPhillips H, Davis R. Are Language Barriers Associated With Serious Medical Events in Hospitalized Pediatric Patients? Pediatrics. 2005;116(3):575–579. doi: 10.1542/peds.2005-0521.
    1. Bartlett G, Blais R, Tamblyn R, Clermont RJ, MacGibbon B. Impact of patient communication problems on the risk of preventable adverse events in acute care settings. Cmaj. 2008;178(12):1555–1562.
    1. Karliner LS, Jacobs EA, Chen AH, Mutha S. Do professional interpreters improve clinical care for patients with limited english proficiency? A systematic review of the literature. Health Serv Res. 2007;42(2):727–754. doi: 10.1111/j.1475-6773.2006.00629.x.
    1. Morales LS, Elliott M, Weech-Maldonado R, Hays RD. The impact of interpreters on parents' experiences with ambulatory care for their children. Med Care Res Rev. 2006;63(1):110–128. doi: 10.1177/1077558705283125.
    1. Jacobs E, Chen AH, Karliner LS, Agger-Gupta N, Mutha S. The need for more research on language barriers in health care: a proposed research agenda. Milbank Q. 2006;84(1):111–133. doi: 10.1111/j.1468-0009.2006.00440.x.
    1. Flores G. The impact of medical interpreter services on the quality of health care: a systematic review. Med Care Res Rev. 2005;62(3):255–299. doi: 10.1177/1077558705275416.
    1. Baker DW, Parker RM, Williams MV, Coates WC, Pitkin K. Use and effectiveness of interpreters in an emergency department. JAMA. 1996;275(10):783–788. doi: 10.1001/jama.275.10.783.
    1. Graham EA, Jacobs TA, Kwan-Gett TS, Cover J. Health services utilization by low-income limited English proficient adults. J Immigr Minor Health. 2008;10(3):207–217. doi: 10.1007/s10903-007-9069-3.
    1. Chan YF, Alagappan K, Rella J, Bentley S, Soto-Greene M, Martin M. Interpreter services in emergency medicine. J Emerg Med. 2008. doi:10.1016/j.jemermed.2007.09.045.
    1. Fernandez A, Schenker Y. Time to establish national standards and certification for health care interpreters. Patient Educ Couns. 2010;78(2):139–140. doi: 10.1016/j.pec.2009.12.008.
    1. Jacobs EA, Lauderdale DS, Meltzer DO, Shorey JM, Levinson W, Thisted RA. The impact of interpreter services on delivery of health care to limited English proficient patients. J Gen Intern Med. 2001;16:468–474. doi: 10.1046/j.1525-1497.2001.016007468.x.
    1. Jacobs EA, Shepard DS, Suaya JA, Stone EL. Overcoming language barriers in health care: costs and benefits of interpreter services. Am J Public Health. 2004;94(5):866–869. doi: 10.2105/AJPH.94.5.866.
    1. Jacobs EA, Sadowski LS, Rathouz PJ. The impact of an enhanced interpreter service intervention on hospital costs and patient satisfaction. J Gen Intern Med. 2007;22(Suppl 2):306–311. doi: 10.1007/s11606-007-0357-3.
    1. Norredam M, Mygind A, Krasnik A. Access to health care for asylum seekers in the European Union--a comparative study of country policies. Eur J Public Health. 2006;16(3):286–290. doi: 10.1093/eurpub/cki191.
    1. OECD. OECD Reviews of Health Systems Switzerland. Paris: WHO & OECD; 2006.
    1. Wieland T. Gesundheitsversorgung von Asylsuchenden: Grenzen unseres Gesundheitssystems. Schweizerische Aerztezeitung. 2000;81:2673–2676.
    1. Reinhardt UE. The Swiss health system: regulated competition without managed care. Jama. 2004;292(10):1227–1231. doi: 10.1001/jama.292.10.1227.
    1. Bischoff A, Schneider M, Denhaerynck K, Battegay E. Health and ill health of asylum seekers in Switzerland: an epidemiological study. Eur J Public Health. 2009;19(1):59–64. doi: 10.1093/eurpub/ckn113.
    1. DIMDI. ICD-10. Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme. Band 1. Bern: Hans Huber; 2001.
    1. Hatcher L. A step-by-step approach to using the SAS system for factor analysis and structural equation modeling. Cary NS: SAS Publishing; 1994.
    1. Bischoff A, Bovier P, Rrustemi I, Gariazzo F, Eytan A, Loutan L. Language barriers between nurses and asylum seekers: their impact on symptom reporting and referral rates. Soc Sci Med. 2003;57:503–512. doi: 10.1016/S0277-9536(02)00376-3.
    1. Goldsmith C, Slack-Smith L, Davies G. Dentist-patient communication in the multilingual dental setting. Australian Dental Journal. 2005;50(4):235–241. doi: 10.1111/j.1834-7819.2005.tb00366.x.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe