Philadelphia Study: Language, Transportation Difficulties Get in Way of Health Care for Chinese and Vietnamese Immigrant Children and Families
From January to December 2004, Philadelphia Citizens for Children and Youth explored the barriers that Vietnamese and Chinese immigrant children face in obtaining health care.
Philadelphia Citizens for Children and Youth is a nonprofit organization that works to improve the lives of children.
Key Findings and Recommendations
- The organization found that transportation difficulties and limited proficiency in English were among the greatest obstacles Philadelphia's immigrant children and their families confront when they need health care.
- The organization made recommendations on ways local government and health care providers can help overcome these obstacles to care. These agencies have acted on many of these recommendations, according to the grantee.
The Robert Wood Johnson Foundation (RWJF) provided an unsolicited grant of $50,000 to support this work.
Immigrant children and U.S.-born children of immigrants are the fastest growing segment of the population of children, accounting for nearly 20 percent of all children in the United States, according to the 1997 Current Population Survey.
Although access to public and private health insurance coverage has increased for children of immigrants and their families, coverage itself does not ensure that children will receive appropriate health care. Children of immigrants are more than three times as likely to lack a regular doctor and more than twice as likely to be in fair or poor health, compared with children of native-born citizens, according to an Urban Institute report.
RWJF supports projects that address health and health care problems that intersect with social factors poverty, race, education and housing and affect society's most vulnerable people.
Other grants that have focused on this issue include support for Thomas Jefferson University to develop and implement the Chinese Community Partnership for Health, aimed at improving the health of Asian populations in Philadelphia (see Grant Results on ID# 031226). Philadelphia Citizens for Children and Youth also received a grant under RWJF's Covering Kids and Families® national program.
The goal of this project was to identify barriers that Vietnamese and Chinese immigrant families face in accessing health care in Philadelphia and to create recommendations to help overcome these barriers.
Working with two consultants (one who spoke Vietnamese and one who spoke Chinese), project staff contacted Chinese- and Vietnamese-speaking parents of children in Pennsylvania's Medicaid program to learn about their experiences in obtaining health care. They conducted eight focus groups that included 25 Vietnamese- and 25 Chinese-speaking families, in-depth interviews with five Chinese-speaking families and surveys of 50 Vietnamese- and 50 Chinese-speaking parents.
Project staff also interviewed representatives from the area's three children's hospitals and eight health centers, as well as three managed care organizations that serve Medicaid recipients and 10 health care providers who serve a large number of Chinese- and Vietnamese-speaking families. They also spoke with two staff members from the Philadelphia public schools.
The Philadelphia Citizens for Children and Youth reported the following findings in a report entitled, "Barriers to Health Care for Children on Medical Assistance; A Case Study of Vietnamese and Chinese Speaking Families":
- Children missed doctor's appointments due to transportation difficulties. Eighty-four percent of Vietnamese-speaking families and 65 percent of Chinese-speaking families reported missing at least one health care appointment in the last year because of transportation difficulties.
- Although the state's Medicaid program offers transportation assistance, most immigrant parents did not use the service. Seventy percent of Chinese-speaking families and 60 percent of Vietnamese-speaking families said they did not know about the transportation help.
- Even among the immigrant parents who knew about the transportation benefit, only 2 percent reported ever using it. Pennsylvania is one of the few states where Medicaid recipients must complete a separate application for transportation services, which is available only in English and Spanish. Promotion of the service is limited and only in English.
- Among users of the transportation benefit, few use the public transportation system. Families found the procedure for obtaining reimbursement for bus and subway tokens complicated and, therefore, often paid for public transportation out of their own pockets or used para-transit vans.
- Language had a significant impact on disparities in insurance coverage, access to care and quality of care received.
- Many of the respondents reported difficulty understanding their children's doctors. Eighty-six percent of Vietnamese-speaking parents and 67 percent of Chinese-speaking parents said they rarely or never understand what their child's doctor is telling them.
- Access to trained interpreters was limited. Forty-eight percent of Vietnamese-speaking families and 50 percent of Chinese-speaking families said they had never been offered an interpreter at their child's pediatrician's office. Although all of the children's hospitals had translation services available, the use of these services varied among the hospitals, due in part to staff's inadequate knowledge of them.
- Children frequently serve as interpreters for their parents. Thirty-seven percent of Chinese-speaking and 32 percent of Vietnamese speaking parents reported sometimes or always using a child as an interpreter at medical appointments.
- Many of the parents sought a doctor who spoke their language but they were unable to find one. However, 66 percent of Chinese-speaking and 45 percent of Vietnamese-speaking parents found a doctor that spoke their language.
The grantee suggested a range of specific recommendations to decrease the transportation and language barriers faced by Vietnamese and Chinese immigrant families. Key recommendations included:
- The Department of Public Welfare and its contractors should simplify the process for using the transportation service and rely more on public transportation. They should also promote the availability of services in multiple languages and include prompts in multiple languages on its phone greeting.
- The Department of Public Welfare should modify its contracts with Medicaid managed care organizations to clarify their responsibilities and requirements for serving non-English speaking patients. The contracts should also require that managed care organizations have written plans for dealing with patients with limited proficiency in English.
- Hospitals should have multilingual signs, "I speak" cards that allow patients to point to the language they speak and request an interpreter, and key documents (such as consent forms) available in multiple languages.
The grantee held a forum to present its findings and recommendations (see Bibliography). It drew more than 150 people, including representatives from the children's hospitals and the Pennsylvania Departments of Health and of Public Welfare, who outlined their plans to improve immigrant access to care. The project report, "Barriers to Health Care for Children on Medical Assistance; A Case Study of Vietnamese and Chinese Speaking Families," can be retrieved from the organization's Web site.
AFTER THE GRANT
Because of this work, the Department of Public Welfare included several of the grantee's recommendations in its request for proposals for a new Medicaid transportation contractor. The Department of Public Welfare incorporated sample contract language written by the grantee and a cooperating organization, the Pennsylvania Health Law Project, in its contracts with Medicaid managed care organizations. It includes requirements that managed care organizations develop written plans for serving patients with limited proficiency in English, translate materials into the five major languages in common use in Philadelphia and track patients who need interpreters so that they do not need to ask.
The grantee continues to work with state and local organizations to promote immigrant children's access to health care. It recently completed a similar project focusing on the Spanish-speaking community, which was funded by RWJF's national program Covering Kids and Families Access Initiative.
GRANT DETAILS & CONTACT INFORMATION
Determining the Health Needs of Children of Chinese and Vietnamese Immigrant Families in Philadelphia
Philadelphia Citizens for Children and Youth (Philadelphia, PA)
Dates: January 2004 to December 2004
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Barriers to Health Care for Children on Medical Assistance; A Case Study of Vietnamese and Chinese Speaking Families. Philadelphia: Philadelphia Citizens for Children and Youth, 2004. Also available online.
Report prepared by: Elizabeth Heid Thompson
Reviewed by: Richard Camer
Reviewed by: Marian Bass
Program Officer: Judith S. Stavisky