Collection of Data on Race/Ethnicity and Language Proficiency of Providers
Published Online: December 20, 2013
David R. Nerenz, PhD; Rita Carreón, BS; and German Veselovskiy, MS
Since 1998, a variety of public and private policy initiatives have encouraged health insurance plans to collect data on the race and ethnicity of their members,1 and health plans have also been either encouraged or required to collect data on language needs of members who are not proficient in English.2 The data are used to identify disparities in care, identify targets for quality improvement initiatives, and set priorities for translation and interpretation services. The overall goal is to ensure that access to care and quality of care do not vary as a function of race, ethnicity, or primary language, and to improve healthcare quality for all plan members.
In a closely related set of policy and health plan initiatives, data on the race, ethnicity, and language proficiency of network physicians have also been collected.3 It is presumed, with some empirical justification,4 that physicians who share significant elements of background and culture with patients will find it easier to communicate essential healthcare messages, to better understand patients’ feelings and experiences, and possibly to provide better quality care.5,6
Health plans that have information on the race, ethnicity, and language proficiency of providers can use this information to provide members with the opportunity to voluntarily select providers through a variety of specific mechanisms. Plans can use the information as a foundation for initiatives to increase the racial, ethnic, and linguistic diversity of physicians for inclusion in their provider networks so that there can be network physicians available for members who have linguistic needs or cultural preferences. More specifically, provider information available to members at the time of plan enrollment can include information on race, ethnicity, and language to enable members desiring a physician who can understand their cultural beliefs and language needs to make a selection using information provided by the plan.
Collection of data from physicians or other providers about race, ethnicity, and language poses some unique challenges to health plans. Some providers may be reluctant to provide such data out of concern that patients may actually select against, rather than for, a specific characteristic.7 Providers may also fear that plans might use the information to exclude, rather than include, them in network contracts.8 Providers with moderate fluency in a non-English language may indicate that they speak that language, but actually do not have sufficient proficiency to carry out complex medical discussions with patients.9 Some providers,like some patients or plan members, may not accept or understand the specific race/ethnicity categories and may find it difficult to answer such questions, even if otherwise willing.10 For all these reasons, health plans’ collection of data on the race, ethnicity, and language fluency of providers has been more complex and more challenging than collection of data on the race, ethnicity, and language needs of members.11
The Patient Protection and Affordable Care Act (ACA) of 2010 created an additional element of context for the collection of race, ethnicity, and language data on providers, as it included a requirement that health plans certified for participation in federal and state insurance exchanges include “essential community providers” in order to serve low-income or medically underserved individuals (Section 1311). Although the legislation and associated regulations did not specify race, ethnicity, and language competence as defining characteristics of essential community providers, the law encourages health plans to improve healthcare access for a population of patients who generally access care in medically underserved areas.
Since 2003, America’s Health Insurance Plans Foundation (AHIPF), with funding support from the Robert Wood Johnson Foundation (RWJF), has conducted periodic national surveys of health plans’ collection and use of race, ethnicity, and language data.12 The early surveys in the series focused on collection of data on race, ethnicity, and language preferences of members, but surveys since 2006 have included questions on collection of such data from network providers. In this article, we summarize findings from the 2010 AHIPF-RWJF survey on health plans’ collection of race, ethnicity, and language data from providers and compare responses from 2010 with those of earlier surveys that also included questions designed to collect race, ethnicity, and language data from network providers and health plan staff.
The sampling frame for the 2010 survey was developed using listings in the Atlantic Information Service’s Directory of Health Plans: 2010.13 Leased networks, plans that were no longer in business or had merged, plans with unknown enrollment, and very small plans (enrollment <6500 for commercial, <20,000 for Medicaid, and <5000 for Medicare plans) were excluded, and local/regional subsidiaries of large national companies were collapsed into their respective corporate entities. The final list consisted of 250 plans (both members and nonmembers of America’s Health Insurance Plans [AHIP]), all of which were surveyed. Plans were asked to respond to the survey questions for the product (commercial, Medicare, Medicaid) with the largest enrollment. However, because most health plans had the largest enrollment in a commercial product, 11 multiproduct plans were also asked to respond for 1 additional product, Medicare or Medicaid, so that the distribution of product-specific enrollment in the sample reflected the composition of the industry. Data sampling for previous surveys was described in a previous publication.12
Prior to e-mailing the survey to plans, AHIP utilized multiple internal and external contact lists, information from previous survey responders, and company websites to identify the appropriate plan representative to complete the survey. The AHIP staff also sent invitations to companies in the sample to notify the potential respondents about the upcoming survey and ask to confirm their participation.
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