Questions 46-50 refer to the following passage. PASSAGE 6        Minority populations more often have limited English proficiency compared to their White counterparts in the United States. Individuals of Asian origin or Hispanic are especially likely to face language difficulties, with about 40% of each of these ethnic groups speaking English less than very well, compared to less than 2% among non-Hispanic Whites. About 15% of Native Hawaiians and other Pacific Islanders and 10% of American Indians and Alaska Natives have limited English proficiency. Only 2.5% of non-Hispanic Blacks have limited English proficiency. Consequently, differences in English fluency across these groups help to explain ethnic disparities in certain dimensions of access to care.

       Language barriers to care exist in both primary and acute care settings. In primary care settings, patients with limited English proficiency are less likely to report having a regular source of care, continuity of care, or receipt of screening services, and more likely to report long waits in the waiting room and difficulty obtaining information or advice over the telephone, compared to English-proficient patients. When professional medical interpreter services are provided, language barriers are reduced. However, many community-based clinics and small, private practices do not make use of professional interpreters due to the high cost and inconvenience. Similar barriers exist in acute care setlings, such as hospital emergency departments. At both the national and state levels, various guidelines and legislative mandates have been implemented regarding the provision of culturally and linguistically appropriate care. These laws and recommendations typically apply to health care settings which receive public funding, and in theory should reduce or eliminate language barriers to care. Yet professional interpreter services are underused in these settings, even when mandated by law.

       There are statistically significant differences regarding access to health care between the proficient group and the limited proficiency group. Compared to English proficient individuals, more individuals with limited English proficiency experience forgone care and fewer report health care visits. In addition, fewer non-English-speaking individuals own their home, and more non-English-speaking individuals have less education and live in poverty or near poverty. Hispanics make up the vast majority of the population with limited English proficiency, with non-Hispanic Whites and Asians making up most of the remainder.

       Researchers found that English language proficiency was associated with health care visits but not with delayed or forgone medical care. Measuring visits to a health professional may more directly capture the communication challenges that patients face in health care settings. The reliance on communication presents a potential barrier to care if the patient has limited English proficiency. In addition, individuals who perceive themselves as English-proficient may actually have inadequate levels of English health literacy, thus limiting the potential for dialogue with health care providers. J Individuals with limited English proficiency may have more difficulty acquiring health information about important health care services and relevant disease symptoms, thus attenuating the potential relationship between language proficiency and the measures of health care access.

       Language barriers to health care is also relevant to other multilingual and multicultural countries, such as Australia and Taiwan. Providers, researchers, and policy makers in international settings must also meet the health care needs of increasingly diverse populations. Language barriers in accessing medical care, such as communication difficulties due to discordant languages between patients and health care providers, and previous negative medical experiences that dissuade future attempts to obtain medical attention can be partially explained by socioeconomic and health status factors.

【題組】46. What is the main purpose of the first paragraph?
(A) To remind us that any laws and recommendations applying to health care settings should eliminate language barriers to care in hospital emergency departments
(B) To introduce the main topic—ethnic equalities in the United States, a multilingual and multicultural country
(C) To convey that minority populations with limited English proficiency may have unequal access to health care
(D) To illustrate the point that professional medical interpreter services are provided in many community-based clinics
(E) To reinforce the idea that numerous non-Hispanic Blacks have limited English proficiency