• Elizabeth A Jacobs, Laura S Sadowski, and Paul J Rathouz.
• Collaborative Research Unit, John H. Stroger Jr. Hospital of Cook County, 1900 West Polk Street, 16th Floor, Chicago, IL, USA. ejacobs@rush.edu
• J Gen Intern Med. 2007 Nov 1;22 Suppl 2:306-11.

BackgroundMany health care providers do not provide adequate language access services for their patients who are limited English-speaking because they view the costs of these services as prohibitive. However, little is known about the costs they might bear because of unaddressed language barriers or the costs of providing language access services.ObjectiveTo investigate how language barriers and the provision of enhanced interpreter services impact the costs of a hospital stay.DesignProspective intervention study.SettingPublic hospital inpatient medicine service.ParticipantsThree hundred twenty-three adult inpatients: 124 Spanish-speakers whose physicians had access to the enhanced interpreter intervention, 99 Spanish-speakers whose physicians only had access to usual interpreter services, and 100 English-speakers matched to Spanish-speaking participants on age, gender, and admission firm.MeasurementsPatient satisfaction, hospital length of stay, number of inpatient consultations and radiology tests conducted in the hospital, adherence with follow-up appointments, use of emergency department (ED) services and hospitalizations in the 3 months after discharge, and the costs associated with provision of the intervention and any resulting change in health care utilization.ResultsThe enhanced interpreter service intervention did not significantly impact any of the measured outcomes or their associated costs. The cost of the enhanced interpreter service was $234 per Spanish-speaking intervention patient and represented 1.5% of the average hospital cost. Having a Spanish-speaking attending physician significantly increased Spanish-speaking patient satisfaction with physician, overall hospital experience, and reduced ED visits, thereby reducing costs by $92 per Spanish-speaking patient over the study period.ConclusionThe enhanced interpreter service intervention did not significantly increase or decrease hospital costs. Physician-patient language concordance reduced return ED visit and costs. Health care providers need to examine all the cost implications of different language access services before they deem them too costly.

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