Availability of hospital financial assistance documents in non-English languages

Millions of people struggle to afford hospital care in the US, and individuals who speak languages other than English (LOTE) are particularly vulnerable due to language barriers in understanding and accessing hospital financial assistance policies (FAPs). Nonprofit hospitals are required under Internal Revenue Service (IRS) rules to provide translated financial documents in any language spoken by at least 1000 individuals or 5% of the population in their service area. However, adherence to these requirements is unknown, and to our knowledge, no study has evaluated whether for-profit or government hospitals voluntarily offer translations of FAP documents to aid individuals who speak LOTE.

Cross-sectional study.

We reviewed the websites of all 426 nonfederal hospitals in the 10 most linguistically diverse US core-based statistical areas (CBSAs), focusing on the availability of 4 financial documents in multiple languages: financial assistance policies, plain language summaries, financial assistance applications, and billing/collections policies. We assessed the association between the number of languages served and hospitals' system and ownership status (nonprofit, for-profit, government) using multivariate regression, adjusting for CBSA.

The study findings demonstrate that system-affiliated and nonprofit hospitals provide more translated documents than their for-profit, governmental, and unaffiliated counterparts. Nonprofit hospitals provided significantly more language options across all document types, suggesting compliance with IRS requirements. System-affiliated hospitals also performed better, possibly due to greater administrative resources.

The study highlights a gap in multilingual access among for-profit, governmental, and unaffiliated hospitals, raising concerns that individuals who speak LOTE may face greater challenges navigating financial assistance and medical billing at these hospitals.