This paper presents the findings of cross-sectional national surveys on how Swiss hospitals address the problem of language barriers in health care and how they respond to the high number of allophone patients (i.e. patients who do not speak the local language). Half of the 244 hospital services responding to the questionnaire estimated the proportion of allophone patients to the total number of patients at 1–5%. Only 14% ‘often’ use paid interpreters, 79% rely mostly on relatives, 75% primarily on health staff, and 43% ‘often’ on non-health staff. Only 11% of the hospital services studied have a budget for interpreters, and 17% have access to an interpreter service. Forty-eight percent express the need to have access to interpreter services. The communication management of hospitals dealing with patients speaking one of the most frequent foreign languages is described; these languages are Italian, Spanish, Portuguese, South-Slavic, Albanian, Russian, Kurdish, Turkish, Arabic and Tamil. The discussion addresses quality of care issues for allophone patients, the risk of poor health care outcomes in the absence of interpreters and the potential benefits of using qualified interpreters.