Spanish-Speaking Immigrants’ Access to Safety Net Providers and Translation Services Across Traditional and Emerging US Destinations

December 2016 | Robert A. Nathenson, Brendan Saloner, Michael R. Richards, Karin V. Rhodes | Original Investigation

Policy Points:

  • Latino immigrants have recently spread beyond traditional US enclaves to “emerging destinations.” The arrival of limited English proficiency (LEP) Spanish-speakers to these areas can challenge the health care system, as translation services may not be readily available for LEP patients.
  • Trained auditors posed as family members of LEP patients seeking primary care in a safety net setting. We found substantially lower appointment availability for LEP adults in emerging destinations compared to traditional destinations.
  • Greater bilingual resources are needed within safety net clinics to accommodate LEP Spanish speakers as this population continues to grow and expand throughout the United States.

Context: Recent demographic trends show Latino immigrants moving to “emerging destinations” outside traditional Latino enclaves. Immigrants in emerging destinations with limited English proficiency (LEP) may experience greater challenges finding health care services oriented to their linguistic needs than those in traditional enclaves, especially if the supply of language resources in these areas has not kept pace with new demand.

Methods: This study uses an experimental audit design to directly compare the ability of uninsured Spanish-speaking LEP adults to access interpreter services and to obtain new patient primary care appointments at federally qualified health centers (FQHCs) across traditional and emerging destinations. We additionally compare the appointment rates of English-proficient uninsured and English-proficient Medicaid patients across these destinations that contacted the same FQHCs. English-proficient patients serve as an access benchmark that is independent of differences in Spanish language services.

Findings: Results indicate that LEP Spanish-speaking patients within emerging destinations are 40 percentage points less likely to receive an appointment than those in traditional destinations. English-proficient groups, by contrast, experience similar levels of access across destinations. Disparities in safety net provider access by destination status are consistent with differences in the availability of bilingual services. Ninety-two percent of FQHCs in traditional destinations offered appointments with either Spanish-speaking clinicians or translation services with non-clinical bilingual staff, while only 54% did so in emerging destinations. LEP patients denied care in emerging destinations must also travel greater distances than in traditional destinations to reach the next available safety net provider.

Conclusions: Our findings highlight that current language resources in emerging destinations may be inadequate for keeping up with the transforming needs of the patient population. As the Latino immigrant population continues to expand and diffuse, better accommodation within the health care safety net is likely to increase in importance.

Author(s): Robert A. Nathenson, Brendan Saloner, Michael R. Richards, and Karin V. Rhodes

Keywords: access to health care, Latino, immigration, limited English proficiency.

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Volume 94, Issue 4 (pages 768–799)
DOI: 10.1111/1468-0009.12231
Published in 2016