Health Services Utilization by Low-Income Limited English Proficient Adults
First Online: 09 August 2007 DOI:
Cite this article as: Graham, E.A., Jacobs, T.A., Kwan-Gett, T.S. et al. J Immigrant Minority Health (2008) 10: 207. doi:10.1007/s10903-007-9069-3 Abstract Objectives We evaluated the health care utilization of limited English proficiency (LEP) compared to English proficient (EP) adults with the same health insurance (Medicaid managed care) and full access to professional medical interpreters. Methods Health care utilization over two years was compared for 567 LEP and 1162 EP adults. Multivariate analysis controlled for age, gender, months enrolled in Medicaid and morbidity. Results LEP compared to EP subjects were enrolled longer and more continuously in Medicaid, were 94% more likely to use primary care and 78% less likely to use the emergency department. Specialty visits and hospitalization did not differ. Conclusions When language barriers are reduced and health insurance coverage is the same, LEP patients show ambulatory health care utilization associated with lower cost and more access to preventive care through establishing a primary care home. Keywords Immigrant Refugee Medicaid Managed care Interpreter Ambulatory care Limited English proficiency References
Profile of the Foreign-Born Population in the United States: 2000, Current Population Reports. December 2001:23–206.
US Census Bureau, Health Insurance Coverage: 2000, http://www.census.gov/hhes/hlthins/hlthin00/hi00tc.html.
Mohanty SA, Woolhandler S, Himmelstein DU, et al. Health care expenditures of immigrants in the United States: a nationally representative analysis. Am J Public Health 2005;95:1431–8.
National Health Law Program and the Access Project: 2004. Language services action kit. Washington, DC: National Health Law Program. http://www.healthlaw.org/pubs/2004.
Woloshin S, Bickell NA, Schwartz LM, et al. Language barriers in medicine in the United States. JAMA 1995;273:724–8.
Wilson E, ChenA, Grumbach K, et al. Effects of limited English proficiency and physician language on health care comprehension. J Gen Intern Med 2005;20:800–6.
Jacobs EA, Karavolos K, Rathouz PJ, et al. Limited English proficiency and breast and cervical cancer screening in a multiethnic population. Am J Public Health 2005;95:1410–6.
Perez-Stable EJ, Napoles-Springer AN, Miramontes JM. The effects of ethnicity and language on medical outcomes of patients with hypertension or diabetes. Med Care 1997;35:1212–9.
Tocher TM, Larson E. Quality of diabetes care for non-English-speaking patients: A comparative study. West J Med 1998;168:504–11.
Stein JA, Fox SA. Language preference as an indicator of mammography use among Hispanic women. J Natl Cancer Inst 1990;82:1715–6.
Pachter LM, Weller SC. Acculturation and compliance with medical therapy. JDBP 1993;14:163–7.
Manson A. Language concordance as a determinant of patient compliance and emergency room use in patients with asthma. Med Care 1998;26:1119–28.
Woloshin S, Schwartz LM, Katz SJ, et al. Is language a barrier to the use of preventive services? JGIM 1997;12:472–7.
Jang M, Lee E, Woo K. Income, language, and citizenship status: factors affecting the health care access and utilization of Chinese Americans. Health Social Work 1998;23:136–45.
Derose KP, Baker DW. Limited English proficiency and Latinos’ use of physician services. Med Care Res Rev 2000;57:76–91.
Andrulis D, Goodman N, Pryor C. What a difference an interpreter can make. Health care experiences of uninsured with limited English proficiency. The Access Project, Center for Community Health Research and Action, Brandeis University, Boston, MA; 2002.
Flores G. The impact of medical interpreter services on the quality of health care: a systematic review. Medical Care Res Rev 2005;62:255–299.
Kogan MD, Alexander GR, Jack BW, et al. The effects of gaps in health insurance on continuity of a regular source of care among preschool aged children in the United States. JAMA 1995;274:1429–1435.
Fleiss JL. Statistical methods for rates & proportions. New York, NY: Wiley; 1981.
Sturmer T, Glynn RJ, Kliedsch U, et al. Analytic strategies for recurring events in epidemiological studies: Background and application to hospital risk in the elderly. J Clin Epidemiol 2000;53:57–64.
Berman S, Bondy J, Lezotte D, et al. The influence of having an assigned Medicaid primary care physician on utilization of otitis media-related services. Pediatrics 1999;104:1192–7.
Jacobs EA, Lauderdale DS, Meltzer D, et al. Impact of interpreter services on delivery of care to limited—English-proficient patients. J Gen Intern Med 2001;16:468–74.
Hampers LC, McNulty JE. Professional interpreters and bilingual physicians in a pediatric emergency department. Arch Pediatr Adolesc Med 2002;156:1108–13.
Baker DW, Parker RM, Williams MV, et al. Use and effectiveness of interpreters in an emergency department. JAMA 1996;275:783–8.
Asseyr AF, Businco L. Atopic sensitization in children of Somali immigrants in Italy. J Investig Allergol Clin Immunol 1994;4:192–296.
Sladden MJ, Dure-Smith B, Berth-Jones J, et al. Ethnic differences in the pattern of skin disease seen in a dermatology department—atopic dermatitis is more common among Asian referrals in Leicestershire. Clin Exp Dermatol 1991;16:348–9.
Tedeschi A, Barcella M, Bo GA, et al. Onset of allergy and asthma symptoms in extra-European immigrants to Milan, Italy: possible role of environmental factors. Clin Exp Allergy 2003;33:449–54.
Dervaderics M, Fust G, Otos M, et al. Differences in the sensitization to ragweed pollen and occurrence of late summer allergic symptoms between native and immigrant workers of the nuclear power plant of Hungary. Immunol Invest 2002;31:29–40.
Knox SA, Britt H. A comparison of general practice encounters with patients from English-speaking and non-English speaking backgrounds. Med J Aust 2002;177:98–101.
Haub C. “2006 World population data sheet" The Population Reference Bureau, 2006.
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