Ronak Aggarwal

How do various institutional and systemic factors influence the accessibility and effectiveness of Spanish-English medical interpretation services in U.S. hospitals?

Started Apr. 29, 2025

Abstract or project description

Language access to health care is legally mandated and necessary for equitable care. With more than 25 million Limited English Proficient (LEP) people in the U.S.—two-thirds of whom are Spanish speakers—interpretation services are crucial (Haldar, Pillai, & Artiga, 2023; MACPAC, 2024). Yet, hospitals prioritize less expensive virtual interpretation over quality in-person services (Jacobs, Shepard, Suaya, & Stone, 2004). This research examines how system-level decisions influence Spanish-English interpretation in hospitals. Based on surveys of 20 interpreters, five providers, and four large Georgia hospital system interviews, it reports staffing shortages, a lack of cultural competency training, and workflow integration problems. Interpreters are commonly excluded from urgent care, citing budget and scheduling issues as barriers. Overreliance on virtual platforms negatively affects communication, particularly in high-stakes situations. Without increased enforcement, investment, and policy change, Spanish-speaking patients will experience considerable care gaps. Hospitals must prioritize interpretation in each clinical step, not merely as a box to be checked.