Low levels of uptake of free interpreters by Australian doctors in private practice: secondary analysis of national data

Abstract

Background. One in thirty-five Australians has poor proficiency in English, and may need language support in health consultations. Australia has the world’s most extensive system of fee-free provision of interpreters for doctors, but the degree of uptake relative to need is unknown. Objective. To assess the current unmet and projected future needs for interpreters in Australia in Medicare-funded medical consultations. Method. Secondary analysis of Australian Census, Medicare and Translating and Interpreting Service (TIS) datasets. Age-specific rates of non-Indigenous populations who had self-reported poor proficiency in English were applied to age-specific attendances to general practitioners (GPs) and private specialists to estimate the need for language-assisted consultations in 2006–07. The proportion of services where language assistance was used when needed was estimated through aggregate data from the Medicare and TIS datasets. Results. We estimate that interpreters from the national fee-free service were used for patients with poor proficiency in English is less than 1 in 100 (0.97%) Medicare-funded consultations. The need for interpreters will escalate in future, particularly among those over 85 years. Discussion. Doctors currently underuse interpreters. Increasing the use of interpreters requires education and incentives, but also sustained investment in systems, infrastructure and interpreters to meet the escalation in demand as the population ages. What is known about this topic? Australia is a multilingual country, with 1 in 35 Australians rating their spoken English as poor. Australia is regarded internationally as a model of service provision in its national fee-free rapid-access telephone interpreter service (the Doctors Priority Line) for doctors charging Medicare-rebateable services. Little is known of the extent of uptake of interpreter services by private doctors, relative to estimated patient need. What does this paper add? Using estimates generated from Medicare statistics, Translating and Interpreting Service statistics and rates calculated from ABS data on language proficiency, we estimate that for every 100 people with poor English proficiency who see a private GP or specialist, only 1 will have an interpreter from the free Doctors Priority Line. Although there are interpreter services funded by States and Territories, these are used very infrequently by GPs and consultants in private practice. The demand for interpreters will increase in future as the population ages. What are the implications for practitioners? Even with a free, rapid-access service, doctors underuse interpreters. Public policy should focus on both education and financial incentives to encourage doctors to use interpreters. Future increases in demand for interpreters will require sustained input into developing the interpreter workforce, and training healthcare practitioners and their businesses to be proactive about using interpreters.