Who treats limited English proficient patients? Implications for linguistic access initiatives

Growing linguistic diversity in the United States brings serious challenges for healthcare providers. Federal civil rights policy requires that physicians participating in Medicaid and State Children's Health Insurance Program (SCHIP) provide meaningful access for their limited English proficient (LEP) patients. Key to compliance is the criterion that the provider's responsibility is proportional to the number of LEP patients likely to be served.

This article identifies which physicians are most likely to treat LEP patients and the source of payment for these visits in a traditionally low immigration state.

The study utilizes 2006-2007 survey data from a random sample of 202 South Carolina physicians' practices. Descriptive statistics establish a profile for practitioners who most frequently treat LEP patients, and ordinary least squares models determine the salient characteristics for providers treating LEP patients.

This study finds that public and community clinics and, to a lesser degree, OB/GYN practices, in counties with over 6% Hispanic population provide a disproportionate share of care to LEP patients. Furthermore, 54.7% of LEP visits were uninsured or self-pay, with the result that LEP patients concentrate in practices that serve the uninsured.

Proposals seeking to increase linguistic access by requiring insurers to cover interpretation services are unlikely to achieve more than a limited impact due to the low insurance coverage rates among LEP patients. The burden of compliance with current linguistic access regulations is heaviest for practices that treat the highest proportion of uninsured and that have the fewest resources to meet regulatory requirements.