Promoting Equity in Pediatric Healthcare Through Reimbursement for Language Services

In March 2017, Ms. Coleman’s daughter Justice Hope, who was medically complex and had multiple disabilities, died at age 11. She was the sunshine in the lives of many and communicated using a thousand smiles.

Family Connections with Pediatrics

There were many times when I felt totally alone, scared, and very unsure when trying to get care for my daughter when she was sick. To be honest, it sometimes felt like people were speaking another language. That was not the case, nor the challenge I faced as an English-speaking White woman. But what of my peers who speak a language other than English?

What does a family do when the care they seek for their sick child is delivered in a language they do not speak or read?

The 2022 American Community Survey estimated that nearly 22% of adults in the United States speaks a language other than English, and nearly half of that group identifies as having limited English proficiency (LEP).¹ Another study tells us that over half of children born to immigrants in the US have a parent or caregiver with LEP.² It is easy to imagine how a family member with LEP, or even a child who an English language learner, might face problems getting care. Compared with English-speaking families, those who are linguistically diverse report worse quality of care,³ less access to a medical home,^4-6 experience more adverse medical events,⁷ and are less likely to receive adequate pain treatment.⁸

In this month’s Pediatrics, a new Equity, Diversity, Inclusion and Justice article, entitled “Promoting Equity in Pediatric Healthcare Through Language Services Reimbursement,” touches on a number of aspects, such as legal requirements and implementing policies, of how to provide linguistically affirming care (10.1542/peds.2023-064214).

What does the article discuss?

The authors focus on the laws and policies in place to facilitate language access, as well as the policies to implement the laws. Below are the article’s four topic areas, as well as an example of an issue raised by the authors in each section:

• Professional medical interpretation is an essential part of linguistically affirming care. There are several ways to increase interpreter use, including training for clinicians and staff, documenting preferred language for patients and caregivers, and making interpreters more accessible. The authors stated that some hospitals have been able to use these strategies, but state and federal policies are needed to help make this practice universal.
• Reimbursement for interpretation services is needed. Authors point out that any doctor who receives funds from the U.S. Health and Human Services Agency are required to provide medical interpretation to LEP patients. While the law is clear, who pays for interpretation is state-dependent. And that is where some issues begin to arise.
• Reimbursement needs to include translation services. Translation services (which focus on written words) are different than interpretation (which focus on spoken words), but equally important. Few policies require and pay for translation of written patient materials, such as discharge instructions or prescriptions.
• Clinicians must advocate for interpretation and translation reimbursements. The authors point out that, given that so many children are insured through states, we must advocate for interpreter reimbursement in all state Medicaid and SCHIP (State Children’s Health Insurance Program) programs.

What can you do with this article?

1. Read the article.
2. If you or someone you know needs access to linguistically affirming care, share it with them. Share it with your child’s doctor and talk to them about how to help make sure all families can access care in their preferred language.
3. If you work or volunteer in an advisory or partnership role with doctors and other healthcare providers, use this article to start a discussion about whether your project work considers and helps with linguistically affirming care.

References

1. The United States Census Bureau. Why we ask questions about language spoken at home. Accessed 11/21/2023. Retrieved from: https://www.census.gov/acs/www/about/why-we-ask- each-question/language/
2. Woods T, Hanson D. Over half of children of immigrants are bilingual. Urban Wire. Urban Institute. October 18, 2016. Accessed May 10, 2022. https:// www.urban.org/urban-wire/over- half-children
3. Flores G, Tomany-Korman SC. The language spoken at home and disparities in medical and dental health, access to care, and use of services in US children [published correction appears in Pediatrics. 2009 Oct;124(4):1265]. Pediatrics. 2008;121(6):e1703-e1714. doi:10.1542/peds.2007-2906
4. Flores G, Abreu M, Olivar MA, Kastner B. Access barriers to health care for Latino children. Arch Pediatr Adolesc Med. 1998;152(11):1119-1125.
5. Cohen AL, Christakis DA. Primary language of parent is associated with disparities in pediatric preventive care. J Pediatr. 2006;148(2):254-258. doi:10.1016/j.jpeds.2005.10.046
6. Flower KB, Wurzelmann S, Tucker C, Rojas C, Díaz-González de Ferris ME, Sylvester F. Spanish-Speaking Parents' Experiences Accessing Academic Medical Center Care: Barriers, Facilitators and Technology Use. Acad Pediatr. 2021;21(5):793-801. doi:10.1016/j.acap.2020.10.008
7. Khan A, Yin HS, Brach C, et al. Association Between Parent Comfort With English and Adverse Events Among Hospitalized Children. JAMA Pediatr. 2020;174(12):e203215. doi:10.1001/jamapediatrics.2020.3215
8. Payson A, Pulido A, San Martin S, et al. Inequities in Pain Assessment and Care of Hospitalized Children With Limited English Proficiency. Hosp Pediatr. 2022;12(6):561-568. doi:10.1542/hpeds.2021-006445