How Proficiency in Speaking English Impacts Healthcare Spending

Whether or not a member can speak English fluently may influence their healthcare spending, a recent Health Affairs study uncovered.

From 1999 to 2018, researchers estimated that the number of Hispanic individuals in the US with low proficiency in English doubled. Researchers hypothesized that this language barrier may have an impact on this growing population of members and patients.

The researchers looked at data from the Agency for Healthcare Research and Quality’s Medical Expenditure Panel Survey (MEPS) from 1998 to 2018. To assess the impact of language on healthcare spending, they isolated Hispanic individuals with low English proficiency and compared them to both Hispanic and non-Hispanic individuals with high proficiency in English.

The final study population encompassed over 17,700 individuals who were Hispanic and had limited English capabilities as well as nearly 15,000 Hispanic adults with high English proficiency and over 87,800 non-Hispanic adults with high English proficiency.

“Limited English proficiency is associated with less health care use, whether measured by spending, episodes of care, or prescriptions, even after multiple demographic and health characteristics are accounted for,” the study confirmed.

From 1999 to 2000, Hispanic individuals with low proficiency in English spent on average $1,947 each year in out-of-pocket healthcare spending. Their Hispanic counterparts who were proficient in English spent on average $2,861 annually. Meanwhile, non-Hispanic English speakers spent an average of $4,130 on healthcare during that timeframe.

Seventeen years later, average annual healthcare spending across all three groups had nearly doubled. During that timeframe, the gap in healthcare spending between English-proficient Hispanic individuals and non-proficient Hispanic individuals remained stable, but the gap between non-proficient Hispanic individuals and proficient non-Hispanic individuals grew. 

Between 1999 to 2000 and 2017 to 2018, the gap between non-Hispanic English speakers’ healthcare spending and the healthcare spending of Hispanic individuals with low proficiency in English increased by almost $1,600.

Hispanic individuals with low proficiency in English spent less on every healthcare spending category that the researchers tested. In outpatient healthcare spending, the out-of-pocket healthcare costs were more than $450 less than English-speaking Hispanic adults and over $700 than non-Hispanic English speakers.

Hispanic individuals with low proficiency in English also visited a provider less frequently, had fewer inpatient days, and lower rates of filled prescriptions.

The researchers acknowledged that these results could enable various interpretations. Namely, they could point to over-treatment of English-proficient individuals or under-utilization by Hispanic individuals with low proficiency in English. It could also indicate the existence of a mix of both causes.

However, the researchers noted that over-treatment does not typically produce gaps as large as the ones that they found between Hispanic individuals with low English proficiency and other groups with higher English proficiency. And when put in the context of care disparities between Hispanic and non-Hispanic members, the evidence indicates under-treatment.

The Hispanic community as a whole—English-proficient and not English proficient—faces many barriers to care. 

Hispanic women also have higher rates of uninsurance. Hispanic Medicare beneficiaries are more likely to have no spending on hospital outpatient needs and Part D drugs. During the pandemic, Hispanic patients along with Black individuals were more likely to avoid emergency department care in times of urgent need such as experiencing a heart attack or stroke.

Additional barriers came from changes that the HHS tried to implement to the Affordable Care Act’s protections against discrimination in 2020.

Part of the solution is that payers should provide appropriate reimbursement for language services.

“Addressing language-based access barriers will likely require changes in reimbursement models to ensure that medical interpreters are recognized and compensated as part of the health care team,” the researchers advised.

“At this time only fifteen states’ Medicaid programs or Children’s Health Insurance Programs reimburse providers for language services, and neither Medicare nor private insurers routinely pay for such services.”

It will also be critical that payers and other healthcare stakeholders provide better language options as the healthcare industry further incorporates telehealth and virtual care, the researchers noted.