One of my final meetings in Germany was with Honey Deihimi who directs social integration at the
Federal Commission for Integration in Berlin. Our conversation, where
Honey spoke as a private individual and not as a representative of the German government, mainly revolved around care for immigrants and
refugees in Germany, but as we went on, we talked about medical interpretation.
In the United States, courts interpreted Title VI of the 1964
Civil Rights Act - which states that recipients of federal funds may not run
their programs in such a way as to create discrimination on the basis of race,
color or country of national origin - to mean that medical interpretation was
mandated for any entity receiving federal funds.
This eventually led to the CLAS (National Culturally & Linguistically Appropriate Services) standards in 2000 in order to “Provide effective, equitable, understandable
and respectful quality care and services that are responsive to diverse
cultural health beliefs and practices, preferred languages, health literacy and
other communication needs.” With specific regard to medical
interpretation, it was believed that providing this service had the potential to improve access
to care, quality of care, and, ultimately, health outcomes.
Unfortunately, as of 2013, these standards only hold the status
of recommendations, not enforceable policy.
Still, one hopes that healthcare providers, especially those who see an
ethnically diverse group of patients, will move forward with these
standards. Their efficacy is certainly
without question.
More than 25 million people in the U.S. have limited English proficiency
(LEP), according to the U.S. Census. And when such people need medical care and
do not have access to professional interpretative services, it can lead to negative clinical consequences. One study showed that LEP
patients stayed longer and had to return to the hospital more frequently when
no medical interpreter services were provided, a situation that drives up costs
for hospitals. Also, data have shown that interpretation can improve patients’ utilization of preventive and
primary care services, such as follow-up visits and medications, that
potentially may reduce costly complications from chronic conditions. (Other data about the clinical importance and cost benefits of medical interpretation
can be found here, here, here, here, and here.)
Honey told me that she and others are trying to make the case
in Germany for mandated medical
interpretation. Beyond that it is the
right thing to do, in a growing, mobilized international world, Honey said, it
makes sense to have these services available.
But, “language barriers is one of the biggest obstacles we face,” she
said. Currently, interpretive services
must be provided for people who are blind or deaf, but there is no law or even
policy that requires interpretation to be provided in the medical setting for
those who have limited proficiency in German.
Honey hopes that this situation changes in the future.
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