Impacts of an interpretation fee on immigrants' access to healthcare: Evidence from a Danish survey study among newly arrived immigrants

In 2018, a fee for healthcare interpretation was introduced for immigrants living in Denmark for more than 3 years to incentivize learning Danish faster. Little is known about who is affected and how immigrants experience impacts of the fee.Using survey data from 2021 (n = 486), we analysed prevalence and socio-demographic background of immigrants reporting interpretation needs, and self-reports about whether the fee had impacted their access to healthcare.In the study population, 19% (n = 95) reported interpretation needs. Refugees and their families (OR: 10.2) more often reported interpretation need compared with EU/EEA immigrants, as did immigrants with low education (OR: 1.86), low income (OR: 2.63) or poor self-perceived health (OR: 3.18), adjusted for gender, age, region of residence and length of stay. among immigrants needing interpretation, 42% (n = 69) reported having refrained from seeking healthcare due to the fee, 73% (n = 119) using ad hoc interpreters, and 77% (n = 126) trying to learn Danish faster.Findings suggest that the policy aim of incentivizing host country language acquisition is partly met, but that the fee has unintended consequences in terms of hampered access to healthcare and increased use of ad hoc interpreters, raising concerns about unmet health needs and poorer quality of care for a substantial group. Potential benefits of the policy should be carefully evaluated against severe negative impacts on immigrants' access to healthcare.