Journal Article
. 2005 Mar; 24(2):435-44.
doi: 10.1377/hlthaff.24.2.435.

Pay now or pay later: providing interpreter services in health care

Leighton Ku 1 Glenn Flores  
  • PMID: 15757928
  •     54 citations


Research amply documents that language barriers impede access to health care, compromise quality of care, and increase the risk of adverse health outcomes among patients with limited English proficiency. Federal civil rights policy obligates health care providers to supply language services, but wide gaps persist because insurers typically do not pay for interpreters, among other reasons. Health care financing policies should reinforce existing medical research and legal policies: Payers, including Medicaid, Medicare, and private insurers, should develop mechanisms to pay for interpretation services for patients who speak limited English.

Physicians' ethical responsibilities in addressing racial and ethnic healthcare disparities.
Nathan Bostick, Karine Morin, Regina Benjamin, Daniel Higginson.
J Natl Med Assoc, 2006 Aug 19; 98(8). PMID: 16916132    Free PMC article.
Patient satisfaction with different interpreting methods: a randomized controlled trial.
Francesca Gany, Jennifer Leng, +4 authors, Jyotsna Changrani.
J Gen Intern Med, 2007 Nov 28; 22 Suppl 2. PMID: 17957417    Free PMC article.
The impact of medical interpretation method on time and errors.
Francesca Gany, Luciano Kapelusznik, +4 authors, Jyotsna Changrani.
J Gen Intern Med, 2007 Nov 28; 22 Suppl 2. PMID: 17957418    Free PMC article.
Detection of depression with different interpreting methods among Chinese and Latino primary care patients: a randomized controlled trial.
Jennifer C F Leng, Jyotsna Changrani, Chi-Hong Tseng, Francesca Gany.
J Immigr Minor Health, 2009 May 02; 12(2). PMID: 19408119    Free PMC article.
Health insurance coverage and medical expenditures of immigrants and native-born citizens in the United States.
Leighton Ku.
Am J Public Health, 2009 May 16; 99(7). PMID: 19443829    Free PMC article.
Getting to equal: strategies to understand and eliminate general and orthopaedic healthcare disparities.
Daryll C Dykes, Augustus A White.
Clin Orthop Relat Res, 2009 Aug 06; 467(10). PMID: 19655210    Free PMC article.
Perceptions of school nurses on the challenges of service provision to ESL students.
Marilyn V Whitman, Jullet A Davis, Allison J Terry.
J Community Health, 2009 Dec 17; 35(2). PMID: 20012473
Clinician ratings of interpreter mediated visits in underserved primary care settings with ad hoc, in-person professional, and video conferencing modes.
Anna M Nápoles, Jasmine Santoyo-Olsson, +3 authors, Eliseo J Pérez-Stable.
J Health Care Poor Underserved, 2010 Feb 23; 21(1). PMID: 20173271    Free PMC article.
Reducing clinical errors in cancer education: interpreter training.
Francesca M Gany, Carlos Javier Gonzalez, +4 authors, Jyotsna Changrani.
J Cancer Educ, 2010 Apr 15; 25(4). PMID: 20390395    Free PMC article.
Impact of patient language proficiency and interpreter service use on the quality of psychiatric care: a systematic review.
Amy M Bauer, Margarita Alegría.
Psychiatr Serv, 2010 Aug 03; 61(8). PMID: 20675834    Free PMC article.
Systematic Review.
Language discordance and testing for latent tuberculosis infection among recent Asian and Latino immigrants.
Jennifer C F Leng, Jyotsna Changrani, Francesca M Gany.
J Community Health, 2010 Aug 11; 36(2). PMID: 20697787
Primary language, income and the intensification of anti-glycemic medications in managed care: the (TRIAD) study.
O Kenrik Duru, Dori Bilik, +7 authors, Carol M Mangione.
J Gen Intern Med, 2010 Dec 22; 26(5). PMID: 21174165    Free PMC article.
Evaluation of medical student self-rated preparedness to care for limited English proficiency patients.
Fatima Rodriguez, Amy Cohen, Joseph R Betancourt, Alexander R Green.
BMC Med Educ, 2011 Jun 03; 11. PMID: 21631943    Free PMC article.
Ethnic disparities in self-reported oral health status and access to care among older adults in NYC.
Donna Shelley, Stefanie Russell, Nina S Parikh, Marianne Fahs.
J Urban Health, 2011 Aug 19; 88(4). PMID: 21850607    Free PMC article.
Moving towards culturally competent health systems: organizational and market factors.
Robert Weech-Maldonado, Marc N Elliott, +3 authors, Ron D Hays.
Soc Sci Med, 2012 Jun 01; 75(5). PMID: 22647564    Free PMC article.
"Doctor, what do i have?" Knowledge of cancer diagnosis among immigrant/migrant minorities.
Francesca Gany, Lalanthica Yogendran, +5 authors, Jennifer Leng.
J Cancer Educ, 2012 Oct 25; 28(1). PMID: 23093484    Free PMC article.
Community health center access to resources for their patients with diabetes.
Arshiya A Baig, Cara A Locklin, +8 authors, Marshall H Chin.
J Immigr Minor Health, 2013 Jan 15; 16(3). PMID: 23315014    Free PMC article.
Transcultural psychiatry made simple--asynchronous telepsychiatry as an approach to providing culturally relevant care.
Peter M Yellowlees, Alberto Odor, +8 authors, Donald Hilty.
Telemed J E Health, 2013 Mar 05; 19(4). PMID: 23451812    Free PMC article.
Limited English proficient patients and time spent in therapeutic range in a warfarin anticoagulation clinic.
Fátima Rodriguez, Clemens Hong, +4 authors, Lenny López.
J Am Heart Assoc, 2013 Jul 09; 2(4). PMID: 23832325    Free PMC article.
To 'Get by' or 'get help'? A qualitative study of physicians' challenges and dilemmas when patients have limited English proficiency.
Janet A Parsons, Natalie A Baker, Telisha Smith-Gorvie, Pamela L Hudak.
BMJ Open, 2014 Jun 07; 4(6). PMID: 24902724    Free PMC article.
The Absent Interpreter in Administrative Detention Center Medical Units.
Murielle Rondeau-Lutz, Jean-Christophe Weber.
Health Care Anal, 2014 Sep 06; 25(1). PMID: 25189317
Predictors of language service availability in U.S. hospitals.
Melody K Schiaffino, Mona Al-Amin, Jessica R Schumacher.
Int J Health Policy Manag, 2014 Oct 23; 3(5). PMID: 25337600    Free PMC article.
Hispanic-Asian Immigrant Inequality in Perceived Medical Need and Access to Regular Physician Care.
Stephanie Howe Hasanali, Gordon F De Jong, Deborah Roempke Graefe.
J Immigr Minor Health, 2014 Nov 26; 18(1). PMID: 25420782    Free PMC article.
Interpreting at the End of Life: A Systematic Review of the Impact of Interpreters on the Delivery of Palliative Care Services to Cancer Patients With Limited English Proficiency.
Milagros D Silva, Margaux Genoff, +4 authors, Lisa C Diamond.
J Pain Symptom Manage, 2015 Nov 10; 51(3). PMID: 26549596    Free PMC article.
Systematic Review.
The Association Between Limited English Proficiency and Unplanned Emergency Department Revisit Within 72 Hours.
Ka Ming Ngai, Corita R Grudzen, +3 authors, Alicia Fernandez.
Ann Emerg Med, 2016 Apr 02; 68(2). PMID: 27033142    Free PMC article.
Immigrant Health in Rural Maryland: A Qualitative Study of Major Barriers to Health Care Access.
Thurka Sangaramoorthy, Emilia M Guevara.
J Immigr Minor Health, 2016 Apr 14; 19(4). PMID: 27067310
Convenient Access to Professional Interpreters in the Hospital Decreases Readmission Rates and Estimated Hospital Expenditures for Patients With Limited English Proficiency.
Leah S Karliner, Eliseo J Pérez-Stable, Steven E Gregorich.
Med Care, 2016 Sep 01; 55(3). PMID: 27579909    Free PMC article.
The Association of English Functional Health Literacy and the Receipt of Mammography among Hispanic Women Compared to Non-Hispanic U.S.-Born White Women.
Hajar Kadivar, Kelly M Kenzik, Darren A Dewalt, I-Chan Huang.
PLoS One, 2016 Oct 13; 11(10). PMID: 27732660    Free PMC article.
Communication With Limited English-Proficient Families in the PICU.
Adrian D Zurca, Kiondra R Fisher, +4 authors, Tessie W October.
Hosp Pediatr, 2016 Dec 17; 7(1). PMID: 27979992    Free PMC article.
A Qualitative study of language barriers between South African health care providers and cross-border migrants.
Jo Hunter-Adams, Hanna-Andrea Rother.
BMC Health Serv Res, 2017 Feb 02; 17(1). PMID: 28143514    Free PMC article.
Challenges To Reducing Discrimination And Health Inequity Through Existing Civil Rights Laws.
Amitabh Chandra, Michael Frakes, Anup Malani.
Health Aff (Millwood), 2017 Jun 07; 36(6). PMID: 28583962    Free PMC article.
A Pilot Study to Determine the Effect of an Educational DVD in Philippine Languages on Cancer Clinical Trial Participation among Filipinos in Hawai'i.
Jamie Q Felicitas-Perkins, Melvin Paul Palalay, +4 authors, William S Loui.
Hawaii J Med Public Health, 2017 Jul 20; 76(7). PMID: 28721310    Free PMC article.
Medical Interpreters in Outpatient Practice.
Barb Jacobs, Anne M Ryan, Katherine S Henrichs, Barry D Weiss.
Ann Fam Med, 2018 Jan 10; 16(1). PMID: 29311179    Free PMC article.
Provider use of a participatory decision-making style with youth and caregivers and satisfaction with pediatric asthma visits.
Betsy Sleath, Delesha M Carpenter, +6 authors, Gail E Tudor.
Patient Relat Outcome Meas, 2018 May 23; 9. PMID: 29785146    Free PMC article.
Racial and ethnic differences in the experience and treatment of noncancer pain.
Samantha M Meints, Alejandro Cortes, Calia A Morais, Robert R Edwards.
Pain Manag, 2019 May 30; 9(3). PMID: 31140916    Free PMC article.
Register-based study concerning the problematic situation of using interpreting service in a region in Sweden.
Emina Hadziabdic, Katarina Hjelm.
BMC Health Serv Res, 2019 Oct 24; 19(1). PMID: 31640714    Free PMC article.
Are Trained Medical Interpreters Worth the Cost? A Review of the Current Literature on Cost and Cost-Effectiveness.
Eva J Brandl, Stefanie Schreiter, Meryam Schouler-Ocak.
J Immigr Minor Health, 2019 Jul 01; 22(1). PMID: 31256314
Migrant women's experiences of pregnancy, childbirth and maternity care in European countries: A systematic review.
Frankie Fair, Liselotte Raben, +4 authors, ORAMMA team.
PLoS One, 2020 Feb 12; 15(2). PMID: 32045416    Free PMC article.
Systematic Review.
Perspectives on Hypertension in the New England Cape Verdean Community.
Samantha DeAndrade, Fadya El Rayess, Roberta Goldman.
J Racial Ethn Health Disparities, 2017 Mar 12; 5(1). PMID: 28284019
The evolution of a healthcare interpreting service mapped against the bilingual health communication model: a historical qualitative case study.
Alexander Bischoff.
Public Health Rev, 2020 Aug 11; 41. PMID: 32774991    Free PMC article.
Supply and Demand: Association Between Non-English Language-Speaking First Year Resident Physicians and Areas of Need in the USA.
Lisa C Diamond, Imran Mujawar, +2 authors, Francesca Gany.
J Gen Intern Med, 2020 Jun 04; 35(8). PMID: 32488693    Free PMC article.
A systematic review of practice-, provider-, and patient-level determinants impacting Asian-Americans' human papillomavirus vaccine intention and uptake.
Milkie Vu, Carla J Berg, +4 authors, Robert A Bednarczyk.
Vaccine, 2020 Aug 25; 38(41). PMID: 32829979    Free PMC article.
Systematic Review.
Cultural Considerations in the Assessment of Survivors of Torture.
Sumithra S Raghavan.
J Immigr Minor Health, 2018 Jul 15; 21(3). PMID: 30006802
Linguistic Isolation and Mortality in Older Mexican Americans: Findings from the Hispanic Established Populations Epidemiologic Studies of the Elderly.
Donglan Zhang, Janani Rajbhandari-Thapa, +6 authors, Kerstin Gerst Emerson.
Health Equity, 2021 Jun 08; 5(1). PMID: 34095708    Free PMC article.
The Use of a Mobile Application to Increase Access to Interpreters for Cancer Patients With Limited English Proficiency: A Pilot Study.
Bharat Narang, So-Young Park, +4 authors, Lisa C Diamond.
Med Care, 2019 May 17; 57 Suppl 6 Suppl 2. PMID: 31095059    Free PMC article.
How language barriers influence provider workload for home health care professionals: A secondary analysis of interview data.
Allison Squires, Sarah Miner, +3 authors, Amy Witkoski Stimpfel.
Int J Nurs Stud, 2019 Sep 04; 99. PMID: 31479983    Free PMC article.
An Exploratory Analysis of Patient-Provider Language-Concordant Home Health Care Visit Patterns.
Allison Squires, Timothy R Peng, Yolanda Barrón-Vaya, Penny Feldman.
Home Health Care Manag Pract, 2017 Aug 01; 29(3). PMID: 34257503    Free PMC article.
Quantifying Medical Interpreter Activity: A Time-Motion study.
Frank C Mayer, Danielle L Mosby, +7 authors, Tze Chiam.
Dela J Public Health, 2016 Dec 15; 2(5). PMID: 34466877    Free PMC article.
Language, Interpretation, and Translation: A Clarification and Reference Checklist in Service of Health Literacy and Cultural Respect.
Marin P Allen, Robert E Johnson, Evelyn Z McClave, Wilma Alvarado-Little.
NAM Perspect, 2020 Feb 18; 2020. PMID: 34532683    Free PMC article.
Surgical Residents as Certified Bilingual Speakers: A Quality Improvement Initiative.
Alex Solomon, Nicholas Calotta, +6 authors, Alejandro V Garcia.
Jt Comm J Qual Patient Saf, 2020 Mar 14; 46(6). PMID: 32165106    Free PMC article.
Evidence-based approaches to breaking down language barriers.
Allison Squires.
Nursing, 2017 Aug 12; 47(9). PMID: 28799977    Free PMC article.
Strategies for overcoming language barriers in healthcare.
Allison Squires.
Nurs Manage, 2018 Mar 13; 49(4). PMID: 29528894    Free PMC article.
Breaking through barriers: the need for effective research to promote language-concordant communication as a facilitator of equitable emergency care.
Colleen K Gutman, K Casey Lion, +3 authors, Rosemarie Fernandez.
J Am Coll Emerg Physicians Open, 2022 Jan 25; 3(1). PMID: 35072163    Free PMC article.
General practitioners' experiences in consultations with foreign language patients after the introduction of a user's fee for professional interpretation: a qualitative interview study.
Annette Sofie Davidsen, Johanna Falby Lindell, +5 authors, Susanne Reventlow.
BMC Prim Care, 2022 May 04; 23(1). PMID: 35501707    Free PMC article.