Language Barriers in Health Care: Findings from the KFF Survey on Racism, Discrimination, and Health
In the U.S., there are about 26 million people who have limited English proficiency (LEP), meaning they speak English less than very well, making up about 8% of people ages five and older. Most U.S. adults with LEP speak Spanish (62%), followed by Chinese (7%), Vietnamese (3%), Arabic (2%), and Tagalog (2%), with the remainder speaking a variety of different languages from regions across the world. Hispanic people account for nearly two-thirds (62%) of the LEP population, while over a fifth (22%) of individuals with LEP are Asian. The remainder of individuals with LEP are White (11%) or Black (4%) or of other racial and ethnic backgrounds. Adults with LEP are also more likely to be low-income—nearly one in five individuals with LEP have family income below 200% of the federal poverty level, compared with one in ten English-proficient individuals. This brief examines health care experiences among U.S. adults with LEP, drawing on findings from the KFF Survey on Racism, Discrimination, and Health.1 For more information about U.S. immigrants with LEP, see this brief. The data identify ongoing barriers and disparities adults with LEP face in accessing health care and suggest that having access to providers who speak their preferred language helps reduce these barriers and may improve certain health care experiences.
Health and Health Care Experiences Among Adults with LEP
Adults with LEP report worse health status and increased barriers in accessing health care compared to English proficient adults.2 Adults who have LEP are more likely to report their physical health as “fair” or “poor” compared with adults who are English proficient (34% vs. 19%). Despite this difference in health status, adults with LEP report less use of care and greater barriers to accessing health care compared to their English proficient counterparts. Adults who have LEP are less likely to say they had a health care visit in the past three years than English proficient adults (86% vs. 95%). In addition, consistent with other analysis, adults who have LEP are more likely than those who are English proficient to report being uninsured (33% vs. 7%). They also are less likely to say they have a usual source of care other than the emergency room (74% vs. 88%). Notably, four in ten adults with LEP (39%) say their usual source of care is a neighborhood clinic or health center, highlighting the importance of community health centers in providing linguistically appropriate and culturally competent care.
About half of adults with LEP say they encountered at least one language barrier in a health care setting in the last three years. This includes about a third of LEP adults who say there was a time in the past three years when difficulty speaking or reading English made it hard for them to fill out forms for a health care provider (34%) or communicate with medical office staff (33%), three in ten who report difficulty understanding a health care provider’s instructions (30%), and about a quarter who say language barriers made it difficult to fill a prescription or understand how to use it (27%) or schedule a medical appointment (25%).
Adults with LEP report having positive, respectful interactions with health care providers somewhat less frequently compared to those who are English proficient. Overall, most adults report having mostly positive interactions with health care providers in the past three years, with majorities regardless of English proficiency saying their providers explained things in a way they could understand, spent enough time with them, understood and respected their cultural beliefs, and involved them in decision-making at least most of the time. However, adults with LEP report some of these experiences less frequently compared to those who are English proficient, including a provider explaining things in a way they could understand (81% vs. 89%), spending enough time during visits (68% vs. 76%), and involving them in decision-making about their care (63% vs. 82%).
Adults with LEP express lower levels of comfort asking questions of their health care providers compared to those who are English proficient. While most adults, regardless of English proficiency, say they have felt at least “somewhat” comfortable asking doctors and other health care providers questions about their health or treatment in the past three year, about half (54%) of adults with LEP say they feel “very comfortable,” which is lower than the two-thirds (66%) of English proficient adults who say the same.
About one in five adults with LEP report a negative experience with a provider, one in eight report being treated unfairly or with disrespect, and about half report practicing vigilant behaviors associated with health care visits. Among adults with LEP, one in five reports experiencing at least one of several negative experiences with a health care provider in the past three years, including a provider ignoring a direct request or question (11%), assuming something about them without asking (8%), suggesting they were personally to blame for a health problem (8%), or refusing to prescribe needed pain medication (8%). In addition, one in eight (13%) adults with LEP say there was a time in the past three years when a health care provider or their staff treated them unfairly or with disrespect because of their race or ethnic background or for some other reason. Reflecting these experiences, about half (48%) of adults with LEP say they feel they have to be very careful about their appearance in order to be treated fairly (44%) and/or prepare for possible insults from a provider or their staff (18%) at least some of the time during health care visits. Adults with LEP do not report these experiences at significantly higher rates compared with those who are English proficient.
Importance of Linguistically Concordant Care
Nearly four in ten adults with LEP say fewer than half of their recent health care visits were with a provider who spoke their preferred language. While six in ten (63%) adults with LEP say at least half of their health care visits in the past three years were with a doctor or health care provider that spoke their preferred language, just 28% say that all of them were. Almost four in ten (37%) say that fewer than half of their visits were with a language concordant provider, including 15% who say they had no health care visits in the past three years with a provider who spoke their preferred language. In addition, among adults with LEP, four in ten say fewer than half of their health care visits in the past year were with a provider who shared their racial and ethnic background.
Adults with LEP who have more visits with providers who speak their preferred language are less likely to report facing language barriers while getting health care. Overall, four in ten LEP adults who say at least half of their health care visits in the past three years were with a provider who spoke their preferred language report experiencing at least one language barrier, compared with six in ten among those who had fewer than half of their health care visits with a language-concordant provider. For example, 45% of LEP adults who say less than half of their health care visits were with a provider who spoke their preferred language say they had trouble communicating with medical office staff, compared with 26% of those who had half or more of their health care visits with a language concordant provider.
Adults with LEP who have more visits with a provider who speaks their preferred language are more likely to say they are comfortable asking questions about their health and treatment compared to those with fewer visits with a language concordant provider. Six in ten (61%) LEP adults who had at least half their visits with providers who spoke their preferred language say they have felt very comfortable asking questions compared to four in ten (43%) of those who had fewer visits with a language concordant provider.
Adults with LEP who have more visits with language-concordant providers are more likely to say their providers usually respect their cultural values and beliefs and ask them about social factors like access to work, food, and housing. Among adults with LEP, those who had at least half of their health care visits with a provider who spoke their preferred language are more likely to say their providers understood and respected their cultural values and beliefs most or every time compared with those who had fewer visits with language-concordant providers (87% vs. 76%). While few LEP adults overall say their provider asked them about their work, housing situation or access to food or transportation during recent health care visits, those who had at least half of their visits with language concordant providers are more likely than those who had fewer visits with such providers to say this happened at least most of the time (29% vs. 15%).