Interpreters in the healthcare system

No reimbursement interpreters

Since 2012, reimbursements for interpreters for those that require them are no longer covered by the health care system. This means that health care professionals may be unable to offer the same quality of health care to people who are less proficient in the Dutch language. This is problematic due to the serious nature of medical intervention. How should an obstetrician explain to a patient that they are experiencing a breech birth? And how should a woman make it clear to an obstetrician that she has experienced complications during previous births?

Now that interpreters are no longer covered, the burden of financing this service falls on health care professionals themselves. In practice, however, this has proven difficult to ensure. If hiring an interpreter for a patient costs obstetricians more money than they earn in a morning, they are unlikely to hire one. They may wish to offer quality health care to their patients, but they lack the means thereto. Recent research by the KNMG (2016) shows that the need of hiring professional interpreters is three times larger than actually occurs in practice.

Human rights infringement

According to the PILP, the lack of reimbursement for health care interpreters could infringe on the right to health.

Every person in the Netherlands is entitled to the best physical and mental state of health as possible. This human right is expressed in Article 12 of the International Covenant on Economic, Social and Cultural Rights, and Article 11 of the European Social Charter. Everyone is entitled to facilities, goods, services and circumstances with which the highest possible standard of health can be achieved. Not providing compensation to health care interpreters has a negative effect on the equal (economic) accessibility and quality of health care in the Netherlands.

The Netherlands Institute for Human Rights also considers the deployment of interpreters in healthcare a basic human right, as evidenced in a recent Dutch opinion piece. The Minister of Health, Welfare, and Sport, however, believes that people living in the Netherlands have a responsibility to learn Dutch. As such, she considers the issue to be a ‘question of principle’ and therefore decided not to reimburse for interpreters in healthcare. To this, the Netherlands Institute for Human Rights replied:

‘Discrimination on grounds of nationality, fluency in a language, or residential status is only allowed when an objective justification exists. That is only the case when a measure serves a legitimate aim and the measure is appropriate and proportionate to achieve this aim. The measure of not reimbursing for interpreters for people that are not fluent in Dutch has the aim of pointing out their responsibility of learning the Dutch language. However, it is the health care professionals that have a duty to deliver quality health care and thus deploying an interpreter, not the duty of the patients themselves. This means that the measure is directed towards the wrong group and thus is unfit to achieve the aim.’

The decision not to reimburse for interpreters in health care would thus amount to discrimination on grounds of nationality, fluency in a language, or residential status. The PILP also suspects that not reimbursing for interpreters will result in an even graver infringement on the right to health for marginalised groups who are unable to adequately express themselves in Dutch and lack the financial means to hire an interpreter. These barriers demonstrate that marginalised people may be unfairly impacted, contrary to the principle of equality.

Patients could try to solve this issue by bringing an acquaintance for interpretation. However, this allows for the risk of misinterpretation of medical jargon and infringes on a patient’s right to privacy.

 

What does the PILP do?

The PILP is looking into this issue together with the Royal Dutch Organisation of Midwives (KNOV). The PILP is currently investigating whether, and by what means, a judicial procedure would help protect this right.

Research by PILPG

The Public International Law & Policy Group (PILPG), an independent international research team, examined this issue and has provided the legal framework applicable to the decision made by the Dutch government to cease coverage for health care interpreters. They analysed the role and responsibilities of the Dutch government, municipalities, health insurers and health care professionals in this context. Moreover, they looked at the issue from an international human rights perspective.

Updates

In October 2016, the PILP reached out to The Royal Dutch Organisation of Midwives (KNOV) via their newsletter to gain their perspectives on how the lack of compensation for interpreters has influenced the work of obstetricians in the Netherlands.

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