General Nature of the U.S. Medical Care Delivery System
Two characteristics distinguish the U.S. medical care delivery system from many others. First, it devotes considerable resources to prolonging the lives of seriously ill or injured people. The cost of medical care reflects the enormous investment in research, medication, and technology that this type of care requires.
Second, there is no general, governmentally-supported system for paying individuals' medical costs. That is, there is no national medical care program or national insurance program.
The result of these and other factors is that medical costs in the U.S. are extremely high and they must be paid by the individual incurring them. Individuals can buy health and accident insurance that will pay some of their medical expenses. No health insurance plan readily available to students covers all medical expenses.
What Happens When You Visit a Doctor
When you go to see a doctor, expect many questions. The doctor will expect you to give details about your symptoms--what they feel like, whether they are more noticeable under some conditions than others, how long you have had them, and so on. The doctor will ask you what treatments you have already tried.
In the U.S. health-care system, patients are encouraged to take responsibility for themselves by asking the doctors (or other care-givers) questions about their condition and its treatment. Patients are expected to ask about the costs of recommended treatment, and may be asked to participate in making decisions about treatment and medications. If the doctor does not know the likely costs, someone else in the office should be asked.
You should bring your insurance card with you to all health care appointments.
Health and Accident Insurance
Health Insurance Requirement
The University requires all international students to have health insurance. International students are automatically billed for insurance coverage unless they present evidence that they have comparable insurance under some policy other than the University one. ISSS provides complete information about health insurance requirements and procedures to newly arriving students.
Health Insurance Terminology
Understanding written information or discussions about health insurance requires understanding certain terms. These definitions of common insurance terms come from a publication called "To Your Health," from NAFSA: Association of International Educators:
Claim: A written request by the insured individual for payment by the insurance company for a cost incurred and covered under the insurance policy.
Co-payment: The portion of a covered expense, after the deductible is paid, which must be paid by the insured individual. The co-payment is usually expressed in a percentage, for example, if the insurance company pays 80 per cent of covered charges, the co-payment is 20 per cent.
Cost Containment: Actions or practices designed to minimize costs incurred by both the insured individual and the insurance company. Cost containment helps to maintain reasonable insurance premiums.
Covered Expense: Any expense for which complete or partial payment is provided under the insurance policy.
Deductible: The initial portion of a covered expense which must be paid by the insured person before the insurance policy pays its part of the expense.
Exclusion: Any condition or expense for which, under the terms of the insurance policy, no coverage is provided and no payment will be made.
Fee for Service: Medical care which is provided in exchange for a fee which is paid to the provider at the time the service is rendered.
Insurance Policy: A written contract defining the insurance plan, its coverage, exclusions, eligibility requirements, and all benefits and conditions that apply to individuals insured under the plan.
Insurance Premium: The amount of money required for coverage under a specific insurance policy for a given period of time. Depending on the policy agreement, the premium may be paid monthly, quarterly, semi-annually, or annually.
Lapse in Coverage: After an initial insured period, the period of time during which an individual is uninsured, usually because of failure to pay the premium.
Pre-existing Condition: A condition that existed prior to the commencement of coverage under a given insurance policy. Depending on the policy, a pre-existing condition may be defined as (a) a condition which had its origins prior to the commencement of coverage; (b) a condition which exhibited symptoms prior to the commencement of coverage; (c) a condition for which treatment was sought prior to the commencement of coverage; (d) a condition which was diagnosed prior to the commencement of coverage; or (e) a condition for which treatment was received prior to the commencement of coverage.
Preventive Care: Measures taken in advance of symptoms to prevent illness and/or injury.
Renewal: Paying a premium for an additional period of time (after the initial insurance period has expired) in order to continue coverage.
Coverage Provided by Health Insurance
Health and accident insurance does not cover all medical expenses. In general, it covers the higher costs that result from accidents and serious illness, with associated hospitalization, medical tests, and the services of doctors and nurses. The coverage provided by various health insurance policies varies. Literature accompanying each policy describes what it covers. Of course, policies that are more comprehensive in their coverage are more expensive.
Health and Accident Insurance for International Scholars and Their Dependents
Scholars who are on the University payroll will participate in insurance plans available to University employees. Information is available through your departmental office or at the University Benefits, 120 University Services Building, 319-335-2676. Scholars who are not on the University payroll and who do not have insurance provided by a sponsoring agency must buy one of the group policies designed for foreign students and professionals in the U.S. Information and applications are available at the ISSS.
Student Health & Wellness, 4189 Westlawn South, 319- 335-8370 - Student Health & Wellness (SHW) is the University’s primary clinic for students to go to for health care. Students registered for more than four semester hours are assessed a health fee each semester. This fee allows a student access to the SHW to see a doctor with no office visit charge as many times during the semester as he/she needs. This fee also covers health promotion services across campus and in the clinic including fitness assessments, tobacco cessation, nutrition counseling stress management, sexual health and substance abuse counseling. Patients who have been assessed the health fee still must pay for lab tests, supplies, physicals, immunizations, procedures (such as wart removal) medications and other costs. Students' spouses and children are not eligible for these services. Students should have their current identification (ID) cards and insurance cards with them when going to the SHW.
The mission of the wellness branch of SHW is to support student wellness and learning through educational and health promotion services that help students create healthy lifestyle. Please see http://studenthealth.uiowa.edu/wellness for consultations and programs SHW provides to promote healthy lifestyles.
The SHW hours during the academic year are 8-5 Monday through Friday. See the web site for more hours during breaks and additional information. When SHW is closed, some options are UI Quick Care https://www.uihealthcare.org/quickcare/ and Mercy Urgent Care http://www.mercyiowacity.org/urgent-care. In a medical emergency call 911 or go to the nearest emergency room. The health fee does not cover visits to these clinics or the emergency room. If you want to ask a nurse a health question, call 319-337-9704.
Medical Care for Families - If you are not a student, or if you are a student with dependents, you may find it necessary to locate a doctor or a dentist in the community. Here are some alternatives.
Free Medical Clinic
The Free Medical Clinic exists for people who need to see a doctor or dentist but do not have the money to pay one. The Free Clinic is staffed by volunteer doctors and dentists. It offers services similar to those available in a doctor's office: check-ups, physical examinations, tests for pregnancy, pediatric services, diagnosis of illness, and so forth. It also provides free, confidential, anonymous testing for the HIV virus, a precondition of AIDS. When necessary, it makes referrals to local hospitals. See http://freemedicalclinic.org/ for more information.
Students are encouraged to go to the Student Health & Wellness rather than the Free Medical Clinic. The Free Medical Clinic is not a substitute for a family doctor, since its services are somewhat limited.
Pre-Natal and Maternity Care and Family Planning (Birth Control)
In the United States a woman usually goes to a doctor or clinic for regular checkups during her pregnancy, and has the doctor deliver the baby in a hospital.
A private physician's fee for delivering a baby, including prenatal and postnatal checkup, is around $1,900; the hospital charge is usually between $5,000 and $6,000. Therefore, the total cost of a normal delivery in a hospital ranges from $7,000 to $8,000. If the delivery has complications, the costs can increase greatly--a Cesarean section, for instance, may cost a total of $13,000.
Pregnant women in need of a physician's services can go directly to the Obstetrics-Gynecology Clinic at University Hospitals, 319-356-2294. No referral is needed. If you want to see a particular doctor, you will want to call in advance and make arrangements.
The Family Planning Clinic at University Hospitals can help a student choose a method of birth control (or "contraception"). The Clinic charges according to the patient's ability to pay. Call 866-452-8507 for an appointment. Confidential counseling is provided; female staff are available.
Female staff are also available at Student Health & Wellness, which also provides birth-control information.
The Free Medical Clinic is not equipped to provide maternity care, but does have some birth control information and advice.
The Johnson County Public Health Department, Child Health Clinic (855 South Dubuque Street, Suite 217, 319-356-6060) provides free or very inexpensive services for infants from two months through children 16 years old. The Department operates a well-child clinic where an infant who is not sick can go for regular check-ups and immunizations. To use the clinic you must live in Johnson County and have a regular physician. Call to arrange a clinic appointment.
The Visiting Nurse Association (1524 Sierra Street, 319-337-9686) provides home visits for mothers with new babies and for the elderly. They also have some infant and toddler car seats available for use by families who need then.
Planned Parenthood of Greater Iowa, at 850 Orchard Street, 319-354-8000, can help a student in choosing a method of birth control. They also do routine gynecological exams and pregnancy testing and counseling.
The Emma Goldman Clinic for Women, located at 227 North Dubuque Street, 337-2111, offers a number of programs and activities.
University students and their families may benefit from the use of the Dental Clinic, which is staffed by professional dentists and by students who are training to become dentists and dental hygienists. Services generally cost much less than those of private dentists. Be aware that most health insurance policies do not cover dental care unless it is made necessary by an accident that has injured the teeth or mouth. The Dental Clinic is located in the Dental Science Building. The telephone number is 319-335-7499.
HIV and AIDS
If you are sexually active, you should protect yourself from sexually transmitted infections including HIV (Human Immuno-deficiency Virus) infection. This is the virus that ultimately leads to AIDS (Acquired Immune Deficiency Syndrome). Any person, regardless of sexual preference or race, can become infected with HIV.
HIV can be transmitted:
- By sexual contact (including unprotected sexual intercourse and oral-genital contact) that entails exposure to the partner's bodily fluids (semen and vaginal fluids produced during sexual excitation)
- By direct exposure to infected blood, as happens, for example, when intravenous drug users share needles, or
- From an HIV infected woman to her fetus during pregnancy or childbirth, or, possibly, to her infant during breast feeding.
There is NO risk of transmitting HIV by sharing:
- A bathroom
- A glass or eating utensils
- A swimming pool or recreational facilities, or
HIV is not transmitted by coughing or sneezing and it is safe to hold hands or otherwise touch an infected person. In other words there is no risk of becoming infected by what health professionals call “casual contact” with an infected person. HIV is transmitted only through semen, vaginal fluids, or blood. You cannot tell if a person is infected with HIV by looking at him or her.
Medical facilities in the United States are required by law to protect patients and health care workers from the risk of HIV. It is considered safe to accept medical treatment from a hospital in the United States. Needles are discarded after one use, blood is screened for the virus, and workers are to wear protective clothing.
You can protect yourself from AIDS by not sharing needles with anyone. This includes needles used not just for injecting drugs, but also needles used for acupuncture, ear-piercing, and tattooing. If you engage in sexual activity with another person, always use a condom and/or dental dam to avoid contact between mucous membranes and semen, vaginal secretions, and blood. This will also help protect you from sexually transmitted infections.
If you have any questions about HIV or AIDS, contact your doctor, the Student Health & Wellness, or the Johnson County Department of Public Health AIDS project. Other clinics in Iowa City can also provide Information about AIDS, including Emma Goldman Clinic and the Free Medical Clinic. Both of these clinics offer anonymous testing for HIV.