Collection of Data on Race/Ethnicity and Language Proficiency of Providers | Page 3
Published Online: December 20, 2013
David R. Nerenz, PhD; Rita Carreón, BS; and German Veselovskiy, MS
For those plans that did share information on provider race/ethnicity with members, information on the media used by plans to share that information were available in the 2008 and 2010 surveys. The pattern of media through which plans made this information available to members was similar in the 2 surveys; the most statistically significant change over the 2 years was in providers’ race/ethnicity being more likely to be available through customer services representatives in 2010 than in 2008 (z score = 4.29, P <.01).
Collection of data on languages spoken by providers and staff also showed a modest increase from 2006 to 2010. Increases from 2006 to 2010 were consistent across types of other plan staff. In most subcategories of staff, the percentage of plans reporting collection of language data increased 10% to 20% across the 4 years. Collection of data on languages spoken for “all health insurance plan staff ” increased by 10% (28% to 38%, z score = 3.00, P <.01) during that period of time (Table 5).
Finally, the percentage of plans that reported testing or verifying language proficiency increased approximately 10% for most major types of plan employees (for example, the percentage of customer service staff tested was 29% in 2008 and 40% in 2010; z score = 2.84, P <.01). The notable exception was the category of providers compared to the network providers’ office staff: 5% each for providers and providers’ office staff in 2008 and only 3% for providers and 5% for providers’ office staff in 2010.
Nearly half of responding plans in 2010 reported collecting data on race/ethnicity of providers, but this activity was no more frequent in 2010 than it had been in 2006, and a number of plans that had been collecting race/ethnicity data on providers in 2006 did not continue doing that in 2008 or 2010.
The apparent decrease from 2006 to 2008 (albeit not statistically significant) was somewhat surprising, given that the collection of data on race, ethnicity, and language needs of health plan members has increased steadily for the past 10 or more years.14 Collection of data about providers may be a more sensitive issue. Although the collection and publication of data on provider characteristics would seem to be an essential step to ensuring a diverse and accessible provider network for a diverse health plan membership, concerns about possible exclusions from provider networks or patients choosing against providers of specific backgrounds have raised significant challenges for health plans. Indeed, we found that 15 plans that were collecting data on providers in 2006 were not doing so in 2010. Collecting and providing these data continue to be optional activities for both health plans and providers. Based on personal conversations with health plans that collect these data (Rita Carreón, director, clinical strategies and healthcare equity, America’s Health Insurance Plans, February 8-9, 2012), plans cited limitations in capturing sufficient data on their network providers among other factors such as trust and providers’ concerns related to the use of the data. Collection of data on languages spoken was more common than collection of data on race/ethnicity, probably because of existing accreditation or purchaser requirements to be able to provide services for patients who have limited English proficiency or who prefer communication in languages other than English, as well as the expressed need by plan members for interaction in languages other than English.15 From 2006 to 2010, health plans expanded their collection of language data on network providers and health plan staff, were more likely to test or verify language proficiency of staff, and were more likely to share this information with plan members.
The study findings clearly have limitations. Although the response rate was reasonable for a survey of this type, we did not have data for the complete universe of operating health plans. It is possible that the nonresponding plans were less engaged in issues related to race, ethnicity, and language data collection, so the activity reported here might overstate the level of activity for health plans in general. One might speculate that health plans serving areas with little racial, ethnic, or linguistic diversity would be less likely to invest in data collection and incorporation of data into programs and member materials; however, qualitative data from follow-up interviews on data collection issues related to plan members’ race/ethnicity did not show such a relatiopnship.16 The sample size of plans did not permit a more detailed analysis of the relationship between service area demographics and activities in the area of race, ethnicity, and language data collection. We also were not able to gather information as to why a subset of health plans stopped the collection and sharing of data on physician’ race and ethnicity between 2006 and 2010.
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