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Hidden cost of using interpreters: study
Hidden cost of using interpreters: study
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To be culturally safe, it is either a cost to the patient or a cost to the practice
General practices’ revenues are dented by the hidden cost of using professional interpreters in patient consultations, a study has found.
The study of an inner-city Wellington practice found it earns between $20 and $90 less per 15 minutes if a patient needs an interpreter.
The findings show capitation funding should recognise patients needing interpreters as high needs, because practices are bearing the cost, says specialist GP Samantha Murton, the GP lead of the study’s host, Capital Care Health Centre.
Dr Murton says using professional interpreters needs to be affordable for both patients and practices, as not using them is unsafe.
The study, by University of Otago medical student Andrew Xiao, found the hidden cost was due to the PHO-funded professional interpreter services requiring a double appointment of 30 minutes.
This meant the 92 patients needing interpreters, on average, had twice the number of 15-minute appointments than are covered by capitation funding (4.8 compared with the funded 2.4).
It was found that even charging patients a double fee for the 30-minute interpreter consultation did not cover the loss in capitation income. For example, the practice earned $90 less per 15-minute appointment with a woman Community Services Card holder aged over 65 if she needed an interpreter.
Dr Murton says practices are required to have a 30-minute appointment because using an interpreter is a “double conversation”. But charging patients a double fee doesn’t take into account the fact the practice isn’t getting capitation for the second half of the appointment. “To be culturally safe, it is either a cost to the patient or a cost to the practice [at present].”
The case study was supervised by Otago associate professor and specialist GP Ben Gray, who concluded last year in a Tū Ora Compass Health-funded position paper that funding of interpreter services in primary care is inequitable.
Secondary care has access to a government-funded interpreting service but, with the exception of the former Auckland DHBs and Nelson Marlborough DHB, primary care is excluded. This leaves PHOs and practices using Services to Improve Access (SIA) funding. Tū Ora Compass chief executive Justine Thorpe says SIA funding is generated by Māori, Pacific and quintile 5 populations. Although not all people needing interpreters belong in those groups, it is the only funding stream available to draw on for interpreting.
Ms Thorpe says the need is much greater than the funding available and using SIA money reduces the amount available for the groups for whom it is designed.
In the case study, of the 92 Capital Care patients requiring interpreters, 67 were ethnically Chinese and the majority did not fit the SIA funding criteria. Patients had access to interpreters for their GP appointments only but, on average, had five other interactions with practice team members.
Dr Gray says the Code of Health and Disability Services Consumers’ Rights needs updating to reflect that telephone and video interpreting services are widely available.
The current right to effective communication includes the right to a competent interpreter, but only “where necessary and reasonably practicable”. Patients should have the right to a professional interpreter if needed.
He says two extensions of primary care access to government-funded interpreting, for COVID-19 and assisted dying, set a precedent.
Dr Gray says these examples set a precedent because: “They have decided you won’t achieve adequate COVID care [for some patients] if you don’t have an interpreter…Why do they think you can achieve adequate care of anything else without an interpreter?”
Ms Thorpe says Tū Ora is calling for a nationally consistent, quality interpreting service.
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