Introduction of user fee for language interpretation: effects on use of interpreters in Danish health care

Abstract

Amendments to the Danish Health Act were introduced in 2018 that stated immigrant patients who have resided in Denmark for more than 3 years have to pay user fees for interpretation in health care. The aim of the study was to explore, how the use of interpreters was affected by the introduction of user fees for interpretation. Results showed a considerable decrease in interpretation services following the introduction of the fee. It is likely to assume that the reduced utilization of interpretation services is highly related to the fee. Further research is needed about the consequences of underutilization of interpretation services.

Health-care encounters without interpreters: a qualitative study of the impact of user fees on interpretation in Danish health services

“…This finding is in line with other studies that show how fees for interpreting services, as well as for preventive health care and curative services, might lead to a decline in the use of (not the need for) such services [Ministerie van Volksgezondheid Welzijn en Sport (Ministry of Public Health Well-being and Sports), 2013; De Boe, 2015; Michaëlis, Krasnik and Norredam, 2021] and ultimately to a lower use of necessary health-care services (Danish Medical Association and The Danish Institute for Human Rights, 2019) as well as lower compliance (Van Wieringen, et al , 2002). In this way, user fees create not only a structural barrier to accessing professional interpreting services but also a barrier to access and use health-care services for many minority-language patients (Flores, 2005; Iliadi, 2008; Donnelly et al , 2011; Ohtani et al , 2015; Gil-Gonzalez et al , 2015; O’Donnell et al , 2016; Floyd and Sakellariou, 2017; Mangrio and Sjögren Forss, 2017; Czapka, Gerwing and Sagbakken, 2019; de Moissac and Bowen, 2019; Al Shamsi et al , 2020; Rasi, 2020).…”

“…However, studies have also shown that a decline in the utilization of interpreting services can be observed following the introduction of user fees for such services [Ministerie van Volksgezondheid Welzijn en Sport (Ministry of Public Health Well-being and Sports), 2013; De Boe, 2015; Danish Medical Association and The Danish Institute for Human Rights, 2019; Michaëlis, Krasnik and Norredam, 2021]. This is in line with our findings and suggests that the fee creates an additional practical barrier to accessing the necessary assistance in the recommended and preferred form.…”

“…Following the introduction of the user fee, a considerable decline in the use of professional interpreters has been documented (Michaëlis, Krasnik and Norredam, 2021), as well as an increased use of informal interpreters, such as family and friends (Danish Medical Association and The Danish Institute for Human Rights, 2019). While informal interpreters may sometimes be preferred by patients and physicians for reasons of logistics as well as fidelity (Zendedel et al , 2018), and although errors also occur in encounters mediated by professional interpreters, studies find that untrained, informal interpreters may be more likely to commit errors in medical interpreting, including omissions, misinterpreting and editorialization (Flores et al , 2003).…”

Unlocking the mechanisms of change in the MAMAACT intervention to reduce ethnic disparity in stillbirth and newborns' health: integration of evaluation findings

“…Persons with mental or physical diseases can be exempted from the co-payment. Previously, interpretation was without user payments, and after the amendments, the use of interpreter services dropped (38).…”

Interpreter services and effect on healthcare - a systematic review of the impact of different types of interpreters on patient outcome

“…It was shown prior to implementation of the current law that the use of professional interpreters in Danish health care was lacking and with possible impact on quality of care ( Lund Hansen MT 2013 ). A recent review showed a decrease in use of interpreters since implementation of the law in 2018 ( Michaëlis et al., 2021 ), possibly reducing quality of care for patients in need of interpreter service even further.…”