No reimbursement for interpreters
Since 2012, interpreters in health care are no longer reimbursed. This means that healthcare providers can provide less quality care to people who do not speak the Dutch language well. This is worrisome. How should an obstetrician explain to a patient what a breech presentation is? How can a woman tell her midwife that she had complications during her previous deliveries?
Now that healthcare interpreters are no longer reimbursed, healthcare providers (the doctor, or midwife) have to pay for this themselves. In practice, however, this proves very difficult. For example, for nurses, who have their own practice, hiring an interpreter for an hour can cost more than they earn in a whole morning. They want to provide good care to their patients, but do not have the resources to do so. A recent study instituted by the KNMG (2016) found that the need to use professional interpreters is three times greater than actually happens in practice.
Infringement of human rights
According to PILP, not reimbursing interpreters in health care may violate the right to health.
Everyone in the Netherlands has the right to the best possible physical and mental health. This human right is established, among other things, in Article 12 International Covenant on Economic, Social and Cultural Rights and Article 11 European Social Charter. The right to health implies that everyone has the right to facilities, goods and services and conditions by which the highest possible standard of health can be achieved. If interpreters are not reimbursed, this could negatively affect the quality and equal (and economic) accessibility of health care.
Also according to the Human Rights Board, the use of an interpreter in health care is a human right, according to an opinion piece. The Minister of Health, Welfare and Sport believes that people living in the Netherlands have their own responsibility to learn Dutch. It is therefore a “principled choice” of the minister not to reimburse interpreters. On this, the Board says:
‘Discrimination on the basis of nationality, language proficiency or residence status is only allowed if there is an objective justification for it. This is the case if the measure serves a legitimate aim and the means is suitable and proportionate to achieve the aim. Not reimbursing
of an interpreter for people who do not speak Dutch well, aims to make them aware of their own responsibility to learn Dutch. However, it is the health care provider and not the patient who, out of his duty to provide good care, is responsible for engaging
a professional interpreter. This means that the measure hits the wrong group and is therefore not suitable to achieve its goal.’
The discrimination based on nationality, language proficiency or residency status by not reimbursing interpreters would therefore not be permissible. PILP also suspects that the non-reimbursement of interpreters in health care will be a greater infringement on the right to health of poorer people who do not speak Dutch well because they cannot afford an interpreter themselves. This also violates the principle of equality.
Finally, patients may decide to solve this problem by bringing a family member or acquaintance. But then the question remains whether the medical jargon is adequately translated and thus proper care can be provided. Moreover, their right to privacy comes into play.
What is PILP doing?
PILP is looking at this problem together with KNOV. PILP is investigating whether, and in what way, legal proceedings can help protect the right to (equal) health care.
Research by PILPG
The Public International Law & Policy Group (PILPG), an independent international research group has been investigating this. PILPG mapped the legal framework applicable to the Dutch government’s decision to stop reimbursing interpreters in health care. They analyzed the role and responsibility of the Dutch government, municipalities, health insurers and health care providers in this context. They also looked at the (international) human rights framework.
