In 2018 Denmark introduced an obligatory user payment for the use of an interpreter in the health care sector, for those migrants that are in need of professional interpretation and have already been living in the country for more than three years. The idea behind this requirement is that it will encourage foreigners to learn the Danish language and thereby improve their integration. Those most affected by the change are likely to be third-country nationals (TCNs), mainly refugees, for whom it is often more difficult to learn the Danish language to a high level due to various obstacles.

The user payment was first introduced in 2011, but withdrawn soon after following protest from doctors, the Danish Medical Association and the Danish Institute for Human Rights. It was then re-introduced in 2018. This qualitative study examines the user payment policy from perspectives of health and safety, ethics, and the law, and investigates the experiences of general practitioners (GPs) in introducing the fee.

Key findings

According to the GPs interviewed in the course of the study, those patients in need of an interpreter are now almost exclusively bringing family members or friends to translate (or attending appointments without an interpreter at all). This can cause several issues, due to both the interpreter's relationship with the patient and their lack of professional training. Without the presence of professional interpreters who are fluent in the language, communication with non-fluent patients is very difficult; even more so when a patient has a chronic condition or psychological / psychosocial problems. GPs also highlighted challenges related to cultural barriers. 

Conclusions

The report observes that when mutual understanding is limited in this way there is a risk of lower-quality treatment at many stages of health care, which both threatens the health of patients and presents GPs with ethical and legal dilemmas. The report states that migrant patients should now be considered a 'critical case' in health care, and concludes that the new user fee policy is leading to:

• insufficient understanding between doctor and patient during consultations;
• risk of inadequate treatment of vulnerable patients;
• risk of inequality of access to knowledge.