Languages Spoken by Patients and Hospital-Based Providers in California
In 2023, 41 of 44 county groupings had hospital patients who spoke a non-English language, but there were no available hospital-based providers fluent in that language.
Why are Languages Spoken by Patients and Providers Important?
Language concordance is when patients and healthcare providers communicate in the same language. Communicating in the same language is essential for a successful relationship between patients and healthcare providers. Language concordance is associated with better communication, a reduction in misdiagnoses and medical errors, and improved patient quality and safety.
By assessing patient preferred language and languages spoken fluently by providers, possible gaps in language concordance by hospital county can be identified.
Due to the data available, these visualizations only represent potential language gaps at the county level; providers may not have actually delivered care in a given language to patients with that preferred language.
Key Findings
- Statewide, 42 out of the 45 languages evaluated had one or more counties with patient encounters in that specific language but no hospital-based provider licenses who are fluent in those languages.
- Spanish has the highest statewide patient encounter to provider license ratio out of the 45 featured languages, at 33.5 patient encounters to 1 provider license, followed by Tongan with a ratio of 27.1 patient encounters to 1 provider license.
Patient Encounter to Provider License Estimated Ratios
The patient encounter to provider license estimated ratios by language allows users to compare ratios for a selected language across counties, along with the statewide ratio comparison. The patient encounter to provider license ratios by county shows the language ratios for a selected county, along with the statewide ratio in the tooltip.
Patient encounter to provider license ratios are a way to compare the count of patient encounters with a preferred language to provider licenses who are fluent in this same language by county. This allows users to see the patient demand for a specific language, as the average number of patient encounters per provider license. Due to the analysis being conducted at the county-level, this visualization is not an analysis of languages spoken by providers who actually delivered care to patients that speak that language.
The larger the patient encounter to provider license ratio, the greater the patient demand for a specific language. Counties with no provider licenses that are fluent in the selected language are represented by the lighter blue bars at the top. Counties with at least one provider fluent in the selected language are represented by the dark blue bars. If a county’s patient encounter to provider license ratio is greater than the statewide ratio or if the county has no provider licenses fluent in that language, then this county is considered as having a greater need than statewide. If the county’s patient encounter to provider ratio is equal or lower than the statewide ratio, then this county has an equal or less need than statewide. In counties where the ratio is <1 patient encounter to 1 provider license, there is a greater number of provider licenses who are fluent in that language than patient encounters in that language. Languages where there are no providers and no patient encounters in a given county were omitted.
Distribution of Language Groups Spoken by Patient and Hospital-Based Providers by County
For each county, the visualization shows the distribution of 1) hospital patient encounters by language group and 2) hospital-based provider licenses by language group.
Distribution of Specific Languages Spoken by Patient and Hospital-Based Providers by County
For each county, the visualization shows the distribution of 1) hospital patient encounters by specific language, with a filter for Medi-Cal threshold and concentration languages and 2) hospital-based provider licenses by specific language, with a filter for Medi-Cal threshold and concentration languages. Medi-Cal threshold and concentration languages are languages that are spoken by 3,000 Medi-Cal beneficiaries or 5% of each county’s total Medi-Cal beneficiary population, whichever is lower. Navajo Language, Sign Language, and Spanish Language are language groups made up of one language and are omitted from the specific languages breakdown.
How HCAI Created This Product
- For hospital-based provider licenses, active licenses were identified where the primary or secondary practice setting was Hospital – Inpatient, Hospital – Outpatient, or Hospital – Emergency Department. Responses are from the HCAI Health Workforce License Renewal Survey data as of December 2024, which contains survey responses collected from December 2022 to December 2024. Respondents were asked to select all languages they spoke fluently/well enough to provide direct services to clients. The responses were adjusted using cell-based weighting to create estimates of the full population. Due to licensees being able to select more than one language per response, percentages across languages for hospital-based provider licenses may not sum to 100.
- Patient encounters were identified from 2023 Emergency Department, hospital-based Ambulatory Surgery, and acute care Patient Discharge Data encounters. Hospital county is used for this analysis. Due to each encounter having one preferred language spoken, percentages across languages for patient encounters sum to 100.
- Medi-Cal Threshold/Concentration languages were retrieved from the California Department of Health Care Services as of July 2021.
- There were 46 specific languages (45 non-English languages displayed) that the health workforce data and patient-level administrative data have in common. Languages not found in both data sources were removed. English is in included in the denominator to calculate percentages. There was no minimum encounter or provider license threshold for languages included in this visualization.
- Language groups are composed of the following specific languages:
| African Languages | Amharic, Swahili, Yoruba |
| Asian and Pacific Islander Languages | Cantonese; Yue Chinese, Mandarin, Fijian, Filipino; Tagalog, Gujarati, Hindi, Hmong, Ilocano; Iloko, Indonesian, Japanese, Khmer; Mon-Khmer, Korean, Lao, Mien; Iu Mien, Panjabi; Punjabi, Samoan, Telugu, Thai, Urdu, Vietnamese |
| European Languages | Croatian, French, French Creole, German, Greek, Hungarian, Italian, Polish, Portuguese, Russian, Serbian, Ukrainian, Yiddish |
| Middle Eastern Languages | Arabic, Armenian, Farsi; Persian, Hebrew, Turkish |
| Navajo Language | Navajo |
| Sign Language | Sign Language |
| Spanish Language | Spanish |
Applying Data De-Identification Guidelines
To protect patient personal information, the California Health and Human Services Agency has adopted a policy of statistically masking or de-identifying sensitive data (CalHHS Data De-Identification Guidelines). For the visualizations above, several methods have been applied to prevent providing the exact count of encounters for small groups of individuals.
The methods are as follows:
- To reduce the risk of re-identification, counties are grouped to ensure that the population is greater than 20,000 individuals and that the county contains more than one acute care facility.
- Counts of Spanish Language Group encounters are rounded to the nearest tens place value before calculating the percentages and patient encounter to provider license ratio.
- In cases where there are no provider licenses, but there are less than 30 patient encounters for a specific language, counts of patient encounters are replaced with “Less than 30” patient encounters in the patient encounter to provider license ratio.
Note: All percentages and ratios are calculated using these updated numbers, not the original number of encounters.
Additional Information
Topic: Healthcare Utilization / Health Workforce
Source Link: Healthcare Utilization- Patient-Level Administrative Data / HCAI Health Workforce Languages Spoken Data
Citation: HCAI – Patient Discharge Data; HCAI Emergency Department Data; HCAI Ambulatory Surgery Data; HCAI Health Workforce Languages Spoken Data
Temporal Coverage: 2023
Spatial/Geographic Coverage: Statewide and County
Frequency: Annually