CALIFORNIA HEALTH PLANS AND LANGUAGE ACCESS
1. Health Plan Services For Patients Who Do Not Speak English Well
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The HMO Report Card on health plans in California is on the web at www.hmohelp.ca.gov. |
The Department of Managed Health Care (DMHC) and the Office of Patient Advocate (OPA) were required by the state legislature to issue an HMO Report Card on health plans in California. The health plans provided all information voluntarily, showing their commitment to help patients make informed choices about their health care and the health plan that best fits their needs. The HMO Report Card, released on September 24, 2001, rates health plans on several quality indicators such as Managing Disease and Staying Healthy. Several of the indicators target diseases and conditions such as high blood pressure, diabetes and asthma which research shows affect communities of color disproportionately. This information on how health plans care for conditions in which there are well-established racial disparities is a key indicator of the responsiveness of health plans to the needs of all Californians.
The HMO Report Card also provides information on whether health plans offer certain services for people who do not speak English well. Given California's increasing cultural and linguistic diversity, access to services that are linguistically appropriate are a necessity for millions of patients. This is the first time that a report card has included information about language access and it is a significant step forward in addressing the needs of people who do not speak English well. Health advocates around California applaud the DMHC and OPA for including this critical information and look forward to improving the cultural and linguistic information to be included in the HMO Report Card next year.
Unfortunately, the DMHC was able to include only a small portion of the information it collected from health plans on cultural and linguistic issues. This report fills in some of the missing pieces of information on cultural and language services offered by the health plans discussed in the HMO Report Card.1 It explains how and why this information is important for patients, and gives more details about the services that health plans provide to people who do not speak English well. In addition, it provides some simple tips for patients on what to look for regarding culturally and linguistically appropriate services. This way, families can make more informed choices on selecting the health plan that best fits their needs.
2. HELPING PATIENTS COMMUNICATE WITH PROVIDERS
Patients and health care providers must be able to communicate with each other. If a doctor can't ask the patient basic questions about what is wrong, her medical history, and circumstances of the illness, the doctor is less likely to be able to diagnose the patient quickly and accurately. Even if the doctor does manage to figure out what is wrong with the patient and recommends treatment, the patient may not understand the diagnosis or treatment options, and may not understand instructions for taking medications.
Does the Health Plan give members a list of bilingual providers?
Health plans have many options to make sure that patients and providers are able to communicate with each other. The best option is to help patients select a bilingual provider who fluently speaks the language preferred by the patient. If the doctor and patient speak the same language, they will be able to communicate with each other and are more likely to have a successful medical encounter. Health plans often provide patients with an online or printed provider directory of physicians and other health care providers in their regional area. Some health plans include the provider's language skills in their directory, making it easier for patients to select a provider who is bilingual and can communicate with them more effectively. Unfortunately, bilingual provider directories may not always be up-to-date, and often include the languages spoken by the provider's staff. This makes it unclear whether the provider is actually bilingual or whether they use a staff person, who may not be trained as an interpreter, to communicate with patients who speak certain languages.
Aetna US Healthcare |
Blue Cross |
Blue Shield |
CIGNA HealthCare California |
Health Net |
Health Plan of the Redwoods |
Inter Valley |
Kaiser |
Lifeguard |
National Med |
Pacifi-Care |
Universal Health Care |
Western Health Advantage |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
Unclear |
Yes |
Yes |
Yes |
Yes |
No |
Yes |
Unclear |
Unclear |
Medicare Only |
No |
In Develop-ment |
Unclear |
3. Interpreters
Friends and family are not trained in medical terminology, may not provide correct information, and should not be used as medical interpreters. |
People in California come from many countries and speak a vast number of languages. In some cases, bilingual providers may be unavailable to serve the needs of certain patients. For example, in rural areas, for specialized care, or for less common languages, there may not be a provider locally available who can speak the language required by a particular patient. In these situations, health plans may be able to provide trained medical interpreters to help bridge the communication gap. All interpreter services should be free of cost to most patients.
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"Health Net and it's contracting providers provide [Medi-Cal and Healthy Families] members [who do not speak English well] free interpreter services through [bilingual] staff, telephone interpreters, or face-to-face interpreters. " -Health Net |
Patients should not rely on family members or friends to serve as interpreters. Friends and family members are much less likely to interpret medical information accurately. In addition, both the patient and the person serving as the interpreter may be uncomfortable with sensitive information, and the interaction may no longer be confidential. Children should never be asked to serve as interpreters for their parents or other adults.2 Patients should always request trained medical interpreters to help them communicate during a medical encounter.
4. Does the Health Plan provide face-to-face interpreters?
A preferred method of interpretation is to have a trained medical interpreter in the same room with the doctor and patient. This face-to-face interpretation allows the doctor and patient to communicate freely with each other, and can also facilitate cultural understanding, interpreting of hand gestures and body language, and other non-verbal cues.
Aetna US Healthcare |
Blue Cross |
Blue Shield |
CIGNA HealthCare California |
Health Net |
Health Plan of the Redwoods |
Inter Valley |
Kaiser |
Lifeguard |
National Med |
Pacifi-Care |
Universal Health Care |
Western Health Advantage |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
Unclear |
For some members |
No |
No |
Only for Medi-Cal & Healthy Families |
No |
No |
Yes |
No |
No |
No |
Yes |
Unclear |
5. Does the Health Plan provide telephone interpreters?
When face-to-face interpreters are unavailable, interpreters can still help over the telephone. These telephone interpreters can be helpful in facilitating communication between the doctor and patient, but are not present in the room. Telephone interpreters therefore will not pick up any non-verbal interactions. There are currently several research projects that are studying videoconferencing and other interpretation methods, which may improve the use of telephone interpreters in the future. However, the health plans listed here rely mainly on traditional telephone interpreter services. Some health plans provide face-to-face interpreters for their patients, while others use only telephone interpreters.
Aetna US Healthcare |
Blue Cross |
Blue Shield |
CIGNA HealthCare California |
Health Net |
Health Plan of the Redwoods |
Inter Valley |
Kaiser |
Lifeguard |
National Med |
Pacifi-Care |
Universal Health Care |
Western Health Advantage |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
Unclear |
Yes |
Yes |
Yes |
For Some Members |
In Develp-ment |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
6. NOTIFYING HEALTH PLAN MEMBERS ABOUT SERVICES AND MATERIALS FOR PEOPLE WHO DO NOT SPEAK ENGLISH WELL
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"Information about how to obtain interpreter services and a statement of the Title VI Civil Rights Act is provided in a brochure available at most Health Plan facilities" |
Health plan members who do not speak English well may have difficulty communicating with their health plan. They may not understand how the health plan works, or know what services are available to them. There are many ways that health plans can help patients learn about the services and materials that they can receive. One important step a health plan can take is to notify members that they can request an interpreter at no cost to them.3 Health plans can also translate important membership and patient education materials into the languages read by patients.
Footnotes:
1 Patient advocates received this information by filing a Public Records Request
2 Perkins et al., "Ensuring Linguistic Access in Health Care Settings: Legal Rights and Responsibilities," National Health Law Program and the Henry J. Kaiser Family Foundation; January 1998.
3 The USDHHS OCR Guidance requires all entities that receive federal funds to provide interpreter services at no cost to patients. If a health plan does not receive federal funds, this requirement may not apply.
