AARP Eye Center
High Rates of Limited English Proficiency in Chinese American Community Highlights Necessity of Language Access in Health Care
By Lina Walker, Beth Carter, Daphne Kwok, March 23, 2023 10:55 AM
En español | As the US health care system transforms to more value-based care, patient-centered care has evolved as a movement, from solely treating a disease toward a more holistic understanding of patients’ problems and their desired outcomes. Shared decision making is a way for patients, families and providers to jointly reach a decision about a test or treatment while considering its benefits and harms as well as the patient’s values and tolerance for risk. But how do patients engage in shared decision making or make other health-related decisions when they or their family caregiver have a limited understanding of English?
People with limited English proficiency (LEP, defined as speaking English less than “very well”) are more likely to report problems understanding medical situations. In the US, Asian Americans and Pacific Islanders (AAPI) are the population group most likely to be limited English proficient, with half of AAPI adults 50 and older considered to be such. Among the Chinese subgroup of the AAPI population, the share of those 50 and older with LEP rises to 61 percent. Moreover, over half of Chinese American adults 50 and older with LEP live in a household where no other resident over the age of 14 is proficient in English. The implication: English-only health resources and English-only speaking providers are insufficient to give many patients the information they and their family caregivers need to make informed health decisions that are in their best interest and reflect their values and beliefs.
The issue reaches far beyond the provider, clear to health insurance. The need for language-accessible materials is just as important when it comes to a person selecting the right health insurance product for them and their family. That decision requires understanding of such major (and reasonably complex) matters as what type of benefits are covered by the insurance plan; which clinicians, hospitals, and other health care providers are part of the health insurance network; the cost of monthly premiums; and the expected out-of-pocket costs for medical visits and prescription drugs. For persons enrolling in Medicare, those decisions are further complicated by strict enrollment rules that could have long-term financial consequences if deadlines are missed.
Where does one go if in need of health-related resources in their own language, such as Chinese? For Chinese Americans enrolling in Medicare, the federal Medicare website offers information in Chinese, and the Medicare & You handbook is also available in Chinese. Enrollment and health care decisions, however, are personal, and the limited content available in Chinese written for a broad audience may not be specific enough to help individuals who need assistance. This is particularly the case if individuals also require help getting financial support to afford their health insurance or their health care, such as with the Medicare Savings Program. Those applications are more specific to an individual’s circumstances and LEP Chinese Americans would benefit from having more personalized resources in Chinese.
Given the large number of LEP Chinese Americans, many AAPI organizations engage with their communities to offer Chinese-language resources to help them and their families with enrollment and health care decisions. Although many of these organizations are small and have limited resources, they serve a critical role in connecting people to information and benefits.
It has been a long-standing priority for AARP to ensure that all older adults have the information they need to make informed health decisions. Solving for the needs of people with LEP is paramount to achieving that goal, and the first step is understanding the unmet needs of the AAPI community, beginning with the Chinese American community given its size and rates of LEP. In localities where AAPI organizations are providing Chinese-language resources, AARP is undertaking an exploration, starting it by asking what more could be offered to meet the range of needs of Chinese Americans. Furthermore, we seek to identify the kinds of additional resources needed to help individuals and families who aren’t fortunate enough to live within these circles of support—that is, those lacking the grassroots, organizational support that others might have access to.
On March 28 and March 29, 2023, AARP will bring together Chinese American and AAPI community-based organizations and federally qualified health centers for an off-the-record conversation to surface issues and identify gap-closing solutions. Such efforts are highly relevant to our work, as older adults are more likely to use the health care system than people of other ages.
Choosing the right coverage, whether Medicare or private health insurance, and finding the right care are important to a person’s health and financial security. Among Chinese Americans, the proportion with limited English proficiency is higher among older age groups, with two-thirds of those ages 65 and older considered to be limited English proficient. Particularly for this group, but also for all who have limited proficiency, having access to tools and resources in a language that works for them and their families will help them feel confident in the choices they make, and live with dignity, purpose and good health.