When Indonesian student Melisa Tjong caught seasonal flu last fall, she took medicine at home instead of going to the hospital. In over a week, the stuffy nose and dry cough had not changed, and the fever worsened. Tjong finally called one of her friends for help —she had no idea how to go to the hospital.
""I didn't know what doctor I should meet. I didn't know what procedure that I had to take. And I thought I had to fill out a lot of forms. It was bothersome. I didn't want to do that until [I was] really, really sick,"" Tjong said.
Richard Simpson, the manager of the Student Health Insurance Plan (SHIP), said the second largest health service for international students is emergency room visits, which made up 15 percent of overall SHIP for international students in the last four years. In contrast, only 7 percent of domestic students used the emergency room.
""International students tend to only use health-care services when they are feeling really sick,"" Simpson said.
The rumor about the high expense of medicines in the United States is the biggest obstacle preventing international students from going to the hospital.
Hee Jung Min, a Korean graduate student she said, brought many kinds of medicines to the United States but forgot to bring dental medicine. Her tooth began to bother her after arriving in Madison.
""It hurts me a lot. I am not comfortable at all,"" Min said. ""But I hear that if I go to the dental clinic, I have to pay more than $100 to see the doctor. It's too expensive for me.""
Min passed the dental clinic several times, but she stopped outside as soon as she reminded herself that she had to pay for it. Min's health insurance, SHIP, did not cover the dental services.
""Also it is hard to find out which dental clinic is good,"" Min said. ""I don't want to waste my money on some treatment that doesn't work.""
Min, who has from suffered the toothache throughout the semester, will fly to South Korea to deal with her dental problem on Dec.19, the first day of winter break.
What happens if it doesn't work?
""Some international students don't understand how they can use the services,"" Sarah Van Orman, executive director of University Health Services, said. ""That's more to figure out when they are very ill.""
Although Tjong had gone to the hospital once the previous year, she still had no knowledge about her health insurance.
""I don't know the name of my health insurance company. They sent me a card but I am not sure how to use it,"" said Tjong, whose health insurance plan was different from SHIP because her country sponsored her study.
In fall 2009, 54 percent of the international students had enrolled in SHIP. These students received an instruction book from UHS.
""We make every effort to help international students familiarize themselves with SHIP,"" Simpson said. ""We understand that international students may still have questions after reading the materials, and we always encourage them to contact our office on campus so that we can help them.""
If I go to the hospital, how can I explain the symptoms?
A communication problem can also arise when international students try to use American health services.
Seung Cheon Hong, who came from South Korea, said she wonders how she would communicate her symptoms to doctors if she had to go to the hospital.
However, federal regulation requires that all the hospitals in the United States provide interpreters to assist with foreign language speakers. Whenever necessary, UHS provides interpreters in almost all languages through an AT&T Language Line system.
""I always encourage international students to use an interpreter if needed,"" Van Orman said. ""When communicating with doctors, students may need to use a different vocabulary than they use for their academic work. Students shouldn't feel embarrassed to ask for language assistance. ""
Unfamiliarity with the appointment procedure can make communication even harder.
""I was asked by the nurse a list of questions and waited for half an hour before the results came out. I saw the doctor only for 10 minutes. He didn't do anything, except asking the nurse some questions,"" Tjong said. She was unfamiliar with talking with nurses since she was used to talking directly to specialty doctors in her home country.
""There are certain things that international students might expect doctors to do, but these can be different in America,"" said Van Orman.
A myth about how much it will cost
""I think there are a lot of myths about how much healthcare will cost,"" Van Orman said.
As long as international students buy the SHIP, almost all the expenses at UHS will be covered.
SHIP covers 90 percent of the costs in almost every hospital in Madison and other cities for international students.
""We try to do outreach programs orienting them particularly about SHIP, about what it means. We hope that the students understand that they can come to UHS and it's free,"" Van Orman said.
Are they making any progress?
In fiscal year 2004, 26.4 percent of international students used either medical or counseling services of University Health Services, much lower than the total 50.3 percent.
Statistics published in 2010, however, show more promising results. In fiscal year 2010, international students' utilization rate has increased to 52 percent, only slightly below the overall campus total of 57 percent.
""We have seen that utilization is increasing,"" Van Orman said. ""It's an educational effort we are trying to do.""