Archive for the ‘Medicaid’ Category
Posted in Advocacy, Assistance, Discrimination, Ethics, Global Health, Health Care Marketing, Health Care Reform, Health Disparities, Health Insurance, Health Literacy, Healthcare Inequalities, Hispanic/Latino, Immigrants, Language Access, Language Services, Limited English Proficiency, Medicaid, Promotions, State of Washington, Translation on 20 December 2013 | Leave a Comment »
Posted in Advocacy, Discrimination, Global Health, Health Care Marketing, Health Care Reform, Health Disparities, Health Insurance, Health Literacy, Healthcare Inequalities, Hispanic/Latino, Immigrants, Language Access, Language Services, Limited English Proficiency, Medicaid, State of Washington, Translation, tagged language translations, quality translations, translations, Washington Healthplanfinder, Washington State on 10 December 2013 | Leave a Comment »
The irony was not lost for me that while writing on the positive results of the FDA’s use of translation services, that here in my state, once known as a national leader in language services, we are still struggling to get quality translations for our Health Benefits Exchange (HBE). The efforts to achieve this goal have been a major focus for the Washington State Coalition for Language Access, and its been a year now since we co-authored with Northwest Health Law Advocates the report Language Access in Washington under the Patient Protection & Affordable Care Act expressly for the HBE efforts. Now with 175,000 enrollees, Washington State deserves the praise it’s getting for the record-breaking enrollment figures in the new health insurance marketplace Washington Healthplanfinder, especially compared to the situation in neighboring Oregon and to the federal Healthcare.gov platform. But the picture is much less rosy regarding providing equal access for Washingtonians with limited English proficiency (LEP), who now number some 8% of state population or half-million residents, representing an increase of 210 % in the past decade . Demographic data on enrollees is said not to be available.
We are now less than 2 weeks away from the enrollment deadline for coverage to start Jan. 1, 2014, and the consumer fact sheets that were intended to inform the public of the options under the ACA have not yet been made available to Washington’s LEP population. Even though work began in July to replace the problematic original translations – errors brought to HBE’s attention by advocates- there are still no consumer fact sheets available in Washington’s threshold languages ( in written form these are: Chinese, Lao, Khmer, Korean, Russian, Spanish, Somali, and Vietnamese).
In addition, the Spanish versions of the paper application for Healthplanfinder, while continuing to be publicly available, have contained horrific translation errors. In the section which inquires about the applicant’s citizenship status, the phrase ” Non-citizen legally present in the US” was translated into Spanish to mean just the opposite, i.e., the translation says “ non-citizen not legally present….” , complete with the I-word in Spanish in version #1. After the mistake was identified on Oct. 15 , again by advocates, staff said they took immediate action to have the vendor correct it. The screenshots included here show the sections containing the mistranslations.
Spanish version #1
This one particular error may now have been recently corrected for a 3rd iteration, through volunteer efforts of local language access advocates trying to beat the clock to help consumers. However, we hear anecdotally that more translation concerns persist and can’t be confident that there are not similar errors in the translations in the other languages.
What remains a mystery is how this sorry state of affairs has come about, and if there were ever robust quality assurance measures in the procurement chain for the translations. It is beyond comprehension how such blatant errors could be made given that the work was done by vendors holding official State contracts who must affirm that they use qualified translators and proper translation procedures. And if this is happening in Spanish, the 2nd most used language in both our State and nationally, and thus one for which there is an ample number of nationally-certified translators available to do the work, there is a real reason to fear that similar egregious errors may exist in other language translations.
Shortly before Thanksgiving, HBE staffers announced at a meeting of its Health Equity Technical Advisory Committee, that work halted back in June to create a Language Access Plan (LAP) for the HBE requested by the TAC , will resume in the new year. LAPs are meant to serve as blueprints to guide the work of agencies and programs to comply with the laws requiring they provide language services, and to help prevent the kind of problems that we’ve being seeing here in the other Washington. I’ll continue to report on the work in progress.
Posted in Advocacy, Assistance, Children's Health, Community clinics, Economics of Health Care, Health Care Reform, Health Disparities, Health Insurance, Healthcare Inequalities, Medicaid on 6 May 2012 | Leave a Comment »
In these times of intense attention to healthcare from all quarters of the US, a new study by USA Today and Kaiser Health News reporters focused on community clinics. Over the past 2 decades community clinics have developed from origins often as volunteer-run efforts, to become a vital part of what is called the safety-net. Frequently they now are the sole source of care available to over 20 million people, often as the only providers who will accept patients covered by Medicaid, and for the growing ranks of the uninsured. The sorry state of healthcare access would be far worse if it were not for community clinics. These centers will play an important role too in the reforms set to start in 2014. It is expected that many who will become newly insured by Medicaid will be seeking care at community clinics. Long woefully underfunded, clinics will be eligible to receive help from the $10 billion approved by Congress for expanding their service capacity.
The report entitled Community clinics have odds stacked against them looked at almost 1200 community clinics across the country, and ranked them based on the 6 categories of performance quality measures which federally qualified health centers (FQHCs) must report to the federal government. The categories cover care for patients with diabetes and high blood pressure, rates of screening for cervical cancer and childhood immunizations, plus timeliness of prenatal care and rates of low birth-weight babies.
Using 2010 clinic performance data obtained by FOIA request, the reporting team found wide variations in care by center, by region of the country, and between specific centers in the same city. Generally, clinics in the South performed worse that those in New England, the Midwest, and California. Overall, their survey showed community clinics not performing as well as the national averages for the study parameters .
There is more context to understanding the survey results however, that was not part of the report. The National Association of Community Health Centers issued a statement about the report which while recognizing the value of examining clinic performance, expressed concern about the wrong impressions that the media study might give:
The article disregards the better quality care that most health centers achieve when compared to care provided to other low-income patients elsewhere. However, at least the article does reveal what few Americans realize– that every health center reports on the quality of care their patients receive….
…When you compare the federal data that is the focus of the USA Today article with national data from the National Center for Health Statistics, health centers performed better than national averages for entering women into prenatal care during the first trimester, childhood immunization rates, reduced low birth rates and hypertension control…..
NACHC recently published its report Health Wanted – The State of Unmet Need for Primary Health Care in America which takes an in-depth look at the factors behind the consistent and increasing demand for community clinics, the links to social determinants of health and how funding has not kept up to meet population needs. In FY 2011 for example, only 67 out of some 1900 applications for new health center service sites were funded.
Seattle/Local Health Guide extracted localized figures from the report to create a Washington State Comparison Chart. Janna Wilson, Senior External Relations Officer for the Seattle-King County Department of Public Health shared additional concerns with me in a personal communication, about implications and lack of context for specific data used for the local news article:
The data provided for Public Health represents a small subset of the patients we see—our homeless primary care patients. This is because Public Health’s federal health center grant comes under a targeted program called Health Care for the Homeless. Our federal data report, therefore, is specific to our homeless patients per federal reporting requirements. As you know, homeless patients face barriers that often exacerbate medical and behavioral health conditions and complicate treatment plans.
While most community health center grants and programs are for the general low-income population, some — like ours — target special population groups such as homeless people or migrant workers. There is nothing in the USA Today article that provides this important context. That said, quality improvement is a big part of our program for all our patients, whether homeless or housed.