Access to Care Among Adults with Limited English Proficiency

Ramirez, Natalia; Shi, Kewei; Yabroff, K. Robin; Han, Xuesong; Fedewa, Stacey A.; Nogueira, Letícia

doi:10.1007/s11606-022-07690-3

Cited by 21 publications

(13 citation statements)

References 43 publications

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“…Prior studies have similarly found higher Medicare charges for ED services among hospitals serving greater Hispanic and African American patient populations [ 29 ]. These findings suggest that hospital prices may be higher in communities of residents who may have more difficulty navigating health services and less likely to negotiate or dispute prices [ 31 – 33 ]. However, higher hospital prices for services may also reflect several different factors, including payer mix, hospital characteristics, hospital expenses and market competition [ 34 – 36 ].…”

Section: Discussionmentioning

confidence: 99%

The relationship between community social risk factors and regional hospital-reported cash, negotiated, and chargemaster prices for 14 common services

Chang,

Psek

2024

BMC Health Serv Res

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Background Social risk factors are key drivers of the geographic variation in spending in the United States but little is known how community-level social risk factors are associated with hospital prices. Our objective was to describe the relationship between regional hospital-reported prices and social risk factors by price type (chargemaster, cash, commercial, Medicare, and Medicaid). Methods This cross-sectional analysis used newly available hospital-reported prices from acute general hospitals in 2022. The prices were for 14 common services. Prices were winsorized at 98%, wage index-adjusted, standardized by service, and aggregated to hospital service areas (HSAs). For social risk, we used 23 measures across 5 domains of social risk (socioeconomic position; race, ethnicity, and culture; gender; social relationships; and residential and community context). Spearman’s correlation was used to estimate associations between median prices and social risk by price type. Results Prices were reported from 2,386 acute general hospitals in 45% (1,502 of 3,436) HSAs. Correlations between regional prices and other social risk factors varied by price type (range: -0.19 to 0.31). Chargemaster and cash prices were significantly correlated with the most community characteristics (10 of 23, 43%) followed by commercial prices (8, 35%). Medicare and Medicaid prices were only significantly correlated with 1 measure (all p < 0.01). All price types were significantly correlated with the percentage of uninsured (all p < 0.01). Chargemaster, cash, and commercial prices were positively correlated with percentage of Hispanic residents, residents with limited English proficiency, and non-citizens (all p < 0.05). Conclusions While regional correlations between prices and social risk factors were weak across all prices, chargemaster, cash, and commercial prices were more like closely aligned with community-level social risk factors than the two public payers (Medicare and Medicaid). Chargemaster, cash, and commercial hospital prices appeared to be higher in socially disadvantaged communities. Further research is needed to clarify the relationship between prices and community social risk factors.

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Section: Discussionmentioning

confidence: 99%

The relationship between community social risk factors and regional hospital-reported cash, negotiated, and chargemaster prices for 14 common services

Chang,

Psek

2024

BMC Health Serv Res

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“…[11][12][13][14] There are also well-documented disparities in access to care, adherence to preventive services, and receipt of high quality primary care by LEP status. [15][16][17] Several studies have documented improvement of health outcomes with the provision of language concordant care, underlining the importance of addressing language barriers for patients with LEP. [18][19][20][21] For example, in one study by Parker et al the authors found significant improvements in hemoglobin A1c and LDL cholesterol levels for a sample of LEP patients with type 2 diabetes after the transfer of their care from a language-discordant to a language-concordant provider.…”

Section: Introductionmentioning

confidence: 99%

Association between English Proficiency and Kidney Disease Knowledge and Communication Quality among Patients with ESKD

Martinez,

Warner,

Powe

et al. 2024

Kidney360

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Background: End stage kidney disease (ESKD) is a chronic health condition for which communication between health care teams and patients is important to guide patient self-management activities. Yet little is known about quality of communication among patients with ESKD and their care team members. We examined the influence of patient’s LEP status on communication experiences at one dialysis center. Methods: A survey was administered to adults receiving ESKD care at a dialysis unit within a public health care delivery system between July 2022 and February 2023, to ascertain kidney disease knowledge and perceptions of communication quality with the dialysis care team. Multivariable logistic and ordinal logistic regression models adjusted for age and gender were used to determine associations between LEP status and CKD knowledge. Results: Among 93 eligible patients, 88.2% (n=82) completed the survey. Approximately 37.8% (n=31) had LEP, mean age was 58.8 years, 68.3% were men, mean dialysis vintage was 3.9 years, and 25% had a positive depression screen (LEP 30%; English-proficient 22%). A higher proportion of English-proficient patients screened positive for limited health literacy compared to those with LEP (74.5% vs 38.7%, p=0.002). Overall, knowledge of assigned cause of ESKD (53.4%) and CKD/transplant knowledge (57.3%) was suboptimal. After adjustment, LEP status was not significantly associated with knowing the correct cause of kidney failure (OR=0.49, 95% CI 0.19-1.27) but was significantly associated with having a higher score on a CKD/transplant knowledge scale (OR 3.99, 95% CI 1.66-9.58). Patients with LEP reported poorer communication quality with dialysis providers and staff (less listening, fewer clear explanations, less time spent with patients) compared to English-proficient patients, though differences were not statistically significant. Conclusions: Overall communication between patients with ESKD and members of the dialysis care team was suboptimal, regardless of English proficiency. Interventions to enhance communication for ESKD patients are needed.

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“…Compared to individuals with English proficiency (EP), LEP individuals have significantly worse access and care, including greater difficulty gaining insurance coverage, being less likely to receive preventive care, and more likely to have preventable emergency department visits. [2][3][4] The COVID-19 pandemic amplified the challenges that many individuals face in accessing health care. The percentage of US adults experiencing delayed or forgone medical care during early in the pandemic was estimated to be between 25% to 40%, compared with 8%-14% before the pandemic.…”

mentioning

confidence: 99%

“…Over 25 million individuals in the United States (or 8% of the population) are described as having limited English proficiency (LEP), or as speaking English “less than very well.” 1 These individuals have long encountered a unique set of challenges when accessing health care. Compared to individuals with English proficiency (EP), LEP individuals have significantly worse access and care, including greater difficulty gaining insurance coverage, being less likely to receive preventive care, and more likely to have preventable emergency department visits 2–4 …”

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confidence: 99%

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Delayed and Forgone Health Care Among Adults With Limited English Proficiency During the Early COVID-19 Pandemic

Chang,

Davis,

Berkman

2023

Medical Care

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Background: Individuals with limited English proficiency (LEP) have long faced barriers in navigating the health care system. More information is needed to understand whether their care was limited further during the early period of the COVID-19 pandemic. Objective: To assess the impact of English proficiency on delayed and forgone health care during the early COVID-19 pandemic. Research Design: Multivariate logistic regression analysis of National Health Interview Survey data (July–December 2020; n=16,941). Outcomes were self-reported delayed and forgone health care because of cost or the COVID-19 pandemic. Delayed health care included medical, dental, mental health, and pharmacy care. Forgone health care also included care at home from a health professional. Results: A greater percentage of LEP adults reported delayed (49%) and forgone (41%) health care than English-proficient adults (40% and 30%, respectively). However, English proficiency was not significantly associated with delayed or forgone health care, after adjusting for demographic, socioeconomic, and health factors. Among LEP adults, multivariate models showed that being uninsured, having a disability, and having chronic conditions increased the risk of delaying and forgoing health care. LEP adults of Asian race and Hispanic ethnicity were also more likely to forgo health care while those with 65+ years were less likely to forgo health care. Conclusions: Adults with LEP were more likely to experience challenges accessing health care early in the pandemic. Delayed and forgone health care were explained by low socioeconomic status and poor health. These findings highlight how during a period of limited health resources, deficiencies in the health care system resulted in an already disadvantaged group being at greater risk of inequitable access to care.

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Access to Care Among Adults with Limited English Proficiency

Cited by 21 publications

References 43 publications

The relationship between community social risk factors and regional hospital-reported cash, negotiated, and chargemaster prices for 14 common services

The relationship between community social risk factors and regional hospital-reported cash, negotiated, and chargemaster prices for 14 common services

Association between English Proficiency and Kidney Disease Knowledge and Communication Quality among Patients with ESKD

Delayed and Forgone Health Care Among Adults With Limited English Proficiency During the Early COVID-19 Pandemic

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