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In order to serve its increasingly multi-lingual population, New York State requires interpretation services in all hospitals. But when caring for immigrants, the language barrier is just one of a myriad of issues health providers grapple with. Even though there is no statewide mandate for cultural sensitivity, many doctors say it's become a necessary instrument in providing medical care for the city's immigrant population.

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Health Maintenance Organizations (HMOs) are a form of insurance-financed managed care. In a managed care system, a health insurance plan pays a closed network of doctors and hospitals an annual rate for each enrollee regardless of how much health care that enrollee uses. If a group of enrollees uses less health care than the insurance company paid for in advance, the doctors and hospitals keep the difference as a bonus.

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Victor R. Fuchs is the Henry J. Kaiser Jr. professor of economics and of health research and policy, emeritus, at Stanford University. He is also a Stanford Institute for International Studies (SIIS) senior fellow and a core faculty member with the Center for Health Policy (CHP) and the Center for Primary Care and Outcomes Research (PCOR). He has written extensively on the cost of medical care and on determinants of health, with an emphasis on the role of socioeconomic factors and physician behavior.

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