摘要：Objectives. We examined the relation between parents’ level of English proficiency and their children’s access to health care. Methods. Using the 2001 California Health Interview Survey, we conducted bivariate and multivariate analyses of several measures of children’s access to health care (current health insurance status, usual source of care, emergency room visits, delayed or forgone care, traveling to another country for health care, and perceived discrimination in health care) and their association with parents’ English proficiency. Results. Compared with English-speaking households, children in non–English-speaking households were more likely to lack health insurance, to not have doctor contact, and to go to other countries for health care and were less likely to use emergency rooms. Their parents were less likely to report their children’s experiencing delayed or forgone care or discrimination in health care. Conclusion. English proficiency is a strong predictor of access to health insurance for children, and children in non–English-speaking families are especially likely to rely on other countries for their health care. English proficiency may mitigate the effects of race/ethnicity commonly observed in health care access and utilization studies. The US Census Bureau estimated that 18% of the population aged 5 years and older spoke a language other than English at home, and more than 8% of people living in the United States speak English “less than ‘very well.’” 1 Being non-English speaking has been recognized as an obstacle to receiving health care and can affect the health of specific minority populations, as well as the general population. 2 – 4 Those with limited English proficiency report “lack of knowledge” as an access barrier to health services more frequently than do those who speak English well, and they are less likely to understand their diagnosis, medications, treatment, and follow-up instructions than more proficient English speakers. 5 – 10 Studies have shown that, in various circumstances, non-English speakers are less likely to have a usual source of care; to receive preventive services, follow-up appointments, sufficient information, and adequate therapy; and to participate in medical decisionmaking. 11 – 15 Studies of emergency room use have shown that patients with language barriers also may experience higher admission rates and more diagnostic studies, leading to higher costs for emergency services. 16 – 19 In addition, language barriers have been associated with lacking components consistent with family-centered care, fewer physician visits, lower rates of patient satisfaction, and increased reports of quality of care being adversely affected. 20 – 27 Language barriers have more deleterious effects in vulnerable populations, such as children with special health care needs, partly because of the complexity of some children’s needs and the heightened importance of clear communication between parents and health care providers. 28 Recent studies on adolescents revealed significant psychosocial deficits in the school environment among those whose primary language at home is not English. 29 , 30 To our knowledge, no previous study has examined levels of parental English proficiency and children’s access to health care. The 2001 California Health Interview Survey (CHIS) collected the information necessary to accomplish this analysis. 31 With the assumption that the parent or guardian is the most knowledgeable person about the health and health care of the child and was also the person responsible for helping the child to access health care services, we examined the association between the parent respondent’s level of English proficiency and the child’s access to health care. Considering the barriers faced by those who speak limited English in the general population in accessing and receiving health care, it was hypothesized that children whose parents have limited English proficiency would report lower rates of health care access than would children with English-speaking parents. Our goal was to describe the demographics of children and the prevalence of selected access characteristics by the English proficiency of the responding parent and to examine the independent effects of English proficiency on health care access while controlling for confounding variables.
