14 Culture shock in the U.S.: Healthcare
In Russia, healthcare is provided to all residents through a compulsory state health insurance program known as OMI, which ensures that both citizens and foreign residents have access to public healthcare. People in Russia and in other Russian-speaking countries are not used to paying for a wide variety of medical services, ranging from check-up visits to staying in the hospital with injuries or other serious issues. Once in the hospital, patients can stay for as long as necessary without incurring fees, although there may be charges for expediting tests or for non-mandatory procedures. However, despite this universal coverage, Russia finds itself ranked in the bottom third for population health in the global ratings. The quality of care has further suffered since 2014 due to budget cuts, resulting in criticism of the public healthcare system for its poor organizational structure, insufficient government funding, outdated medical equipment, and low wages for staff. To fill the gaps left by public healthcare, private healthcare options have been available since 1996, with the number of private clinics steadily increasing. Still, the number of people who use private healthcare is considerably smaller compared to those using public healthcare.
One of the culture shocks for Russian-speaking people in the U.S. is the cost of emergency services. In Russia, the ambulance service plays a crucial role in providing emergency care, as it not only transports patients from their homes but also usually includes a doctor who can offer
an initial diagnosis and assistance. This service is provided free of charge, and individuals can call for an ambulance for a range of medical emergencies, including high fevers, drops in blood pressure, or chest pain. In Russia, it is also common to request home visits from doctors rather than going to medical facilities themselves even in cases of minor illnesses. The American reality of driving oneself or someone to the emergency services is very foreign to people from the post-Soviet countries and can cause a major misunderstanding.
Another difference in attitudes toward healthcare is that Russian-speaking people often tend to seek medical advice – or even receive medication – from friends or relatives, contributing to a culture of communal healthcare support.
Additionally, many Russians still rely heavily on home medicine and distrust treatments involving antibiotics. Non-surgical methods are often preferred, and there’s a notable faith in what are sometimes seen as ‘miracle’ pills or treatments.
Volunteers and NGO employees working with Russian-speaking immigrants might find themselves in situations when they need to explain the following:
- Healthcare costs and how they can be covered by the private insurance or Medicaid (the governmental program that is built to provide healthcare for those who do not have the money to pay for private healthcare. Russian-speaking immigrants might be used to seeking medical assistance without checking for covered providers or potential cost of the procedures.
- When and how to get emergency services, what to expect during an emergency response (for example, what types of emergencies would 911 cover), and the potential cost of using an ambulance to ride to the hospital.
- Preparing Russian-speaking immigrants for differences in the length of hospital stays and that they might be released much faster than in their home countries due to different hospital protocols and incurred costs.
- Explaining that in the U.S. it is not common to accept prescription medicine from friends, even as a gesture of goodwill. Giving prescription medicine to someone violates state and federal laws, which can lead to a range of consequences including fines, community service, probation, and even time in prison.
- Explaining the importance of providing all information to the doctor about various home remedies that were used prior to the hospitalization, including herbs, rubs, over-the-counter medicine (including the foreign ones), and homeopathic medicine.
