How much can actually be saved by cutting down on access to interpreters?

The new Swedish government recently put forward a proposal, in the so-called Tidöavtalet, with the ambition to limit government-funded interpreters to citizens and people with a residence permit. But how much will it actually save on the bottom line? And what will the effects be on the healthcare sector?

In Tidöavtalet, the suggestion regarding interpreters is under a section named “Migration and Integration”. Despite this, it will have a significant impact on another area; healthcare.

Basically, by trying to save money in the integration area, it will add costs and take up resources in the healthcare area. Not to mention jeopardize patient safety and make it more difficult for healthcare staff to treat them. This is how:

Takes up more time
Taking care of a patient that is not proficient in the language takes up more time and effort. If people have to pay for interpreters there is a higher chance that they come to their appointment without one. In that situation, staff needs to spend more time out of the appointment to find a phone interpreter on short notice, a colleague that can speak the language or family members. Or just use body language and do guesswork. It will take longer to understand the patient's situation, and symptoms, and to communicate the treatment needed. In emergency departments, patients with language barriers must spend an average of 28 minutes longer than other patients. This is a time that instead can be used to treat other patients.

More equipment & materials are used
More samples and examinations
are ordered for patients with language barriers, to make up for the lack of communication. Healthcare staff simply need to rely on them more heavily to give the patient the right diagnosis. Or examinations might get redone due to misunderstandings. In emergency care, ambulances are sent to non-emergency situations because it is unclear how badly injured the patient is.

More and longer hospitalizations
Nurses also witness that medical care is delayed. Language barriers discourage patients from seeking treatment altogether and they might refrain from it and miss out on opportunities to improve their health (in time).  This is not only an increased cost for the health care provider, but more importantly, it also puts the patient at risk for unnecessary complications.  Patients with a limited language proficiency suffer from 50% more hospitalizations and have an increased length of stay in hospitals (on average 2 days longer). 

Higher risk of readmission
It has also been shown that they have an increased risk of readmission or revisiting the emergency department. This is connected with the patient not understanding information about their condition, what medications to take, and what activities to avoid. Patients with limited language proficiency are 24% more likely to have unplanned ED revisits within 72 hours. 

The suggestion to cut down on interpreters might initially look like a government saving. With a more holistic view, it's clear that healthcare will be less efficient and that will lead to increasing costs overall. Not to mention the administrative costs that will go to debt collection for unpaid interpreter invoices. This is what happened in Denmark where politicians decided that patients who had lived in the country for more than three years had to pay for the interpreter themselves. Just looking at the debt collection, the regions spend more resources collecting interpreters' fees than they would get back from them. So financially, it looks like a pretty bad deal for healthcare providers.

Is it possible to both cut overall costs and language barriers in health care?
Yes, we firmly believe so. By continuing to focus on providing patients with medically authorized interpreters. We fear that with this suggestion, healthcare as an area and patients’ chances for good and equal care will fall victim to the new government’s ambition to achieve a paradigm shift within migration and integration. 

We do welcome one of the other proposals, to increase control and quality assessment for interpreters. Perhaps this will help increase the number of medically authorized interpreters, which is well needed. Today few interpreters have healthcare knowledge and are not available in all languages. 

care to translate app on two iphones

Instead of reducing language support in healthcare, they should explore other types of communication solutions that can act as a compliment to interpreters. A digital solution like Care to Translate could help make the use of interpreters more efficient and cost-effective. Interpreters can be used in situations when they are really needed, and digital solutions could be used in emergency situations, in reception, at admission, during longer hospitalizations, or for recurring appointments. This would lead to both decreased costs for interpreters and higher patient safety. 

No matter if the proposal will be implemented or not, one thing you as a healthcare professional, clinic, or region can do, is to make sure to have other tools and plans for situations where no interpreter is present. The Care to Translate app fills that gap and makes it possible to not leave patients or staff unequipped in these situations. Our intention is never to replace interpreters but to act as a complementary tool. We exist because we know that in reality, these situations are often more complicated. And more common than one might think.