How Overcoming Language Barriers Improves Primary Care Access

Improving patient primary care access may be as simple as connecting that patient with a provider who speaks the same language as them, helping to build stronger patient-provider relationships, instill trust, and ultimately cut emergency department (ED) visits, according to new research.

The study, conducted by non-profit Medicare Advantage plan SCAN Health Plan and published in the Journal of General Internal Medicine, revealed that patients who visit a provider who speaks the same language are more likely to continue making their primary care appointments.

English language proficiency has long been regarded as a key social determinant of health. Patients for whom English is not their first language and who have limited English language proficiency may experience stunted patient-provider communication and unequal opportunity for strong patient engagement and education.

In November 2020, a separate group of researchers found that patients with limited English language proficiency experience all of the same care access barriers English-speaking patients do, but with the added element of language barriers.

Specifically, individuals with limited or no English language proficiency face challenges interacting with front office staff, medical personnel, and organization representatives over the phone, the study found. This comes on top of existing care access barriers patients often face regardless of language preference, like poor facility navigability or lack of convenient appointments.

That can result in poor patient trust and a tendency to disengage with the medical institution, including primary care, and potentially leaving patients to access higher-acuity care in place of low-acuity care management.

This latest data from SCAN Health Plan revealed that connecting patients with clinicians who speak the same language as them can help overcome some of those primary care access roadblocks. The researchers looked at 34,600 SCAN members who did not speak English between January and December 2019. The team compared primary care, specialty care, and ED utilization patterns among those who did visit a clinician who spoke their same language and those who did not.

The researchers found that those members who visited a clinician who spoke their same language had higher primary care utilization rates and lower specialty care and emergency department utilization rates. And among those members who did not speak the same language as their providers, researchers observed the inverse. These patients were less likely to regularly access primary care, but had higher specialty care and ED utilization patterns.

These findings come as healthcare works to both cut healthcare spending—a goal which entails reducing unnecessary ED and specialty care utilization—and improving cultural competency and health equity. According to Dr. Sachin Jain, president and CEO of SCAN Group and one of the study’s authors, those goals can complement each other.

When a patient visits with a provider who also speaks her language, the pair can build a baseline of trust. The patient may also perceive the visit as more fruitful because she can actively engage in shared decision-making and patient education.

For other patients, a language barrier could force a more passive healthcare experience, which they may not perceive as useful. That may lead them to only access care when they are experiencing acute symptoms and push them into the ED or specialty care offices.

“Decreasing healthcare inequities that negatively impact the health and well-being of non-English speaking older adults in the United States is a major focus for SCAN,” Jain stated publicly. “The results of this study are an indicator that that there is an urgent need to provide linguistically and culturally competent care for non-English speaking communities in order to improve their overall population health.”

Some healthcare organizations are working to fill the language gap in the near term using medical interpreters. Digital medical interpreters have also emerged as an accessible and cost-effective strategy. In the long term, organizations should invest in diversifying their medical workforce. Hiring more clinicians who speak languages other than English will make it easier to match them to patients with a shared background.

And as Jain mentioned, working to build cultural competency and responsiveness in all medical personnel will be critical. That level of cultural awareness could help build bonds between patients and providers of discordant language proficiencies, as well.

There is, of course, a moral imperative to these efforts, Jain mentioned. These findings come as healthcare works to address health equity. But it is also impactful for organization bottom lines, he said.

“As encouraging as the results are for improved health, they also suggest that matching patients to a language concordant PCP can lead to significant cost savings, given the increased expense associated with specialist, inpatient, and ED settings,” Jain concluded.

Correction 08/17/2021: A previous version of this article stated that SCAN Health Foundation initiated the study. This article has been updated to reflect that SCAN Health Plan conducted the study.