The number of Latino immigrants in the United States increased from 8.4 million to 16.1 million between 1990 and 2000. More than half of these immigrants have limited English proficiency (LEP). This creates a language barrier between provider and patient in a health care setting that may adversely impact health and health care. In 2002, the Robert Wood Johnson Foundation launched Hablamos Juntos (HJ) to improve access to health care for Latinos with LEP and to explore cost-effective ways for health care organizations to provide access to language services.

In this paper, the authors describe 10 innovative projects from HJ that were designed to reduce language barriers. The experience of the grantees provides guidance for organizations contemplating similar efforts. The study found that most of the program's project leaders did not communicate effectively with physicians about their adoption of innovative language services, and that many underestimated the importance of persuading physicians of the need to hire, support and use qualified medical interpreters in practice settings. Moreover, the annual cost of operating the HJ interventions was $666,000 per site. In addition, the researchers revealed that the field lacks benchmarks and tools for measuring the proficiency level of interpreters, despite the fact that in certain medical encounters a health care professional may require the services of a translator with advanced skills. Regardless of the Foundation's recommendation, most sites had not developed a business case to sustain the interventions.