When first-year doctoral candidate Chen Yao arrived from China to the University of Minnesota, she got her U Card, set up her TCF Bank account, moved into Dinkytown and went to international student orientation.

But how healthcare systems work in the U.S. is still a mystery to Yao. Cultural differences can make even the crucial task of seeing a doctor a challenge for many Chinese students.

Unlike many American students that can be under their parentsâÄô health insurance, international students must purchase a plan through the University before enrolling in classes.

Dave Golden, director of public health and marketing at Boynton Health Service, said international studentsâÄô health benefit plan is not-for-profit and cheap. However, he said many Chinese students do not understand their health plan well, so Boynton holds orientations.

At international student orientation for the fall semester, Boynton representatives gave presentations to new international students to illustrate what the health insurance covers, how to see a doctor in the U.S., what clinics Boynton contains and how students get access to those clinics.

According to the International Student and Scholar Services  fall 2010 census, 4,716 international students were enrolled at the Twin Cities campus, among which 1,910 were Chinese, including from Hong Kong and Taiwan.

Graduate student Snow Wang, who volunteered as an international student representative on BoyntonâÄôs Student Health Advisory Committee last summer, said Boynton orientations give international students a whole picture about how healthcare works in the U.S. However, she said, students still need to go see a doctor themselves if they want to understand the procedure âÄî something of concern to international students because of cultural divides.

Unaccustomed to making appointments

For Americans, making an appointment before seeing a doctor is a common practice. For the Chinese, however, this may seem awkward and confusing. Most healthcare in China is on a walk-in basis.

Some students find it annoying to make an appointment because they wouldnâÄôt have to if they were in China and can become impatient when waiting a week or more to see a doctor.

Soon, students will have access to an online form to fill out an online appointment request, including highlighting an emergency and the date of the appointment, Golden said.

A different role for nurses

Tao Yang, a third-year Chinese graduate student majoring in human resources, was frustrated and confused when he talked with a Boynton nurse on the phone about a fever and diarrhea last November.

The nurse told him the body would recover by itself without any medication. Initially, Yang thought this idea was unacceptable. But when Yang followed the nurseâÄôs instructions and got better the next day, he learned that he can trust nurses in the U.S.

âÄúYou know, when she told me the condition was self-limited, my first reaction was that I did not trust her,âÄù Yang said. âÄúBut when I recovered the next day, I realized that nursing was different here from in China. If you want me to choose which one is better, I would choose the U.S.âÄù

He said he now believes that American nurses are more professional than Chinese nurses. He said in China, nurses just take orders and act as assistants to doctors, whereas American nurses seem capable of instructing patients to take over-the-counter medicine and giving advice on health care issues in general.

Lynn Blewett, a professor in the School of Public Health, said the reason American nurses are more professional is due to AmericaâÄôs more rigid training system.

Blewett said that in America, various types of nurses get degrees ranging from an associate to a masterâÄôs. Registered nurses, for example, have many hours of clinical experience before graduating.
In China, the average nursing diploma is an associate degree which only requires three years of schooling. 

Health insurance works

Opinions differ on whether Chinese students enjoy the best health plan.

Shou-Ching Tang, a Chinese physician and adjunct professor of medicine at the University of Minnesota, said there are several standards to judge a health plan by, like the amount of co-pay required âÄî the less the co-pay is, the more beneficial the plan is, he said.

Other standards include whether the plan provides coverage for preventative care âÄî for example, whether students can get free annual physical exams âÄî or how much the plan covers for out-of-pocket expenses.
He said he judges plans by whether they cover more with less money.

Wang said the plan for international students is good because students pay less to cover more. Plus, Boynton offers free yoga, tai chi and Pilates classes.

After the healthcare orientation, Yao said she was satisfied with her plan because she wonâÄôt face an expensive bill if she saw a doctor in the U.S.

âÄúWhen I was in China, I knew that seeing a doctor is very expensive here,âÄù Yao said. âÄúNow I do not need to worry about that, because my health benefits plan would take care of those bills.âÄù

âÄúWe are trying to find ways to serve Chinese students well,âÄù Golden said, âÄúone of which is to recognize the cultural differences with an open mind.âÄù