Healthcare Utilization and Finance
A1. Comparing the U.S Healthcare System and that of Japan
The majority of developed countries had their healthcare systems developed and standardized in the early years of the 20th century. In this task, we will compare the healthcare system of both the United States and Japan based on various perspectives as outlined below.
A2. A Comparison of the Access of Healthcare Systems for Children, the Unemployed, and the retirees
Japan, just like other countries in Asia, has a centralized healthcare system where the government provides funding to all healthcare activities in the country. In terms of access, there is a significant difference between the healthcare system of the United States and that of Japan. The Japanese government established universal healthcare, which takes care of all citizens plus foreigners with proven eligibility (often one year of stay in the country). Vulnerable groups such as children, the elderly, or retirees, as well as the people without employment, all receive medical cover provided by the government under the universal healthcare program.
On the other hand, the United States has in place the Patient Protection and Affordable Care Act (ACA) popularly known as Obamacare, which was passed in 2010 by the United States Congress. Through ACA, there was a renewed effort that called for shared responsibility between individuals, the government, and employers. Cooperation between the three entities has seen the largest number of Americans in the country’s history put under healthcare coverage. By and large, the quality of healthcare in the country has increased while at the same time, the level of access to exponentially increased mainly due to the affordability. The U.S has a history of fragmented healthcare systems dominated by the private sector, which is often expensive and discriminatory in terms of coverage as well as the rates. The only public options targeting vulnerable groups such as the elderly, the physically challenged, and low-income earners include Medicare and Medicaid. The two are run by both state and federal governments.
Despite the establishment of ACA in 2010, the healthcare environment in the United States is still dominated by private insurance companies that are run at the state level. Similarly, individuals’ insurance services are managed at the state level. Even the people whose insurance coverage is provided by both the federal and state governments are also provided with the option of securing additional private insurers (Griffith, Evans, & Bor, 2017). Children’s access to the healthcare system depends on their parents’ covers. Others, such as the elderly and the unemployed, are either provided with basic coverage under the Medicaid and Medicare or sometimes remain without a medical cover.
A2a. The medication Coverage in both healthcare systems
In the U.S, the private insurers provide their customers with medication coverage as well. Each provider enters into a formal agreement with the clients concerning the nature of cover as well as other details surrounding compensations and repayments. For instance, copayments to every plan depend on a number of issues, such as the cost of medications administered, among others. Additionally, there are low-cost medication options that the government puts in place for the unemployed, the elderly, and the children.
The U.S medication coverage is a complete departure from what takes place in Japan. The Japanese universal healthcare is provided for free of charge to the country’s citizens, foreigners as well as expatriates. It is through the universal healthcare that Medical treatment is provided. Individuals can register to universal healthcare is done through the National Health Insurance System (NHIS) or via the healthcare association plan, which belongs to a pool of employers. Insurance contributions by individuals are always deducted from their salaries. NHIS deductions are made based on an individual’s income (Niles, 2019). The poor, unemployed, as well as the elderly, must register to the NHIS at their local government’s offices. The group is provided free medication cover by the universal healthcare program.
A2b. Referral to see a specialist in both healthcare systems
In Japan, a majority of specialist visits do not require referral. However, the few visits to specialists that take place often charge some little money, mainly serving as an initial consultation fee. The specialists are able to charge such small amounts because the government determines all fees effectively shielding healthcare seekers from exorbitant pricingby specialists in other jurisdictions charge.
The U.S, on the other hand, has several types of insurance plans such as PPOs, HMOs,Medicaid, and Medicare that handle referrals differently. For instance, the PPOs do not require referral for a patient to see a specialist. On the contrary, the HMO requires the PCP to institute a referral process, whereas thepatient undercover signs up to a pool of a limited number of specialists from which a choice can be made upon. Medicare, on the other hand, utilizes a plan similar to that of the PPO. However, Medicaid beneficiaries are always at the behest of specialists since they have the freedom to accept Medicaid as payment or reject.
A2c. Coverage of Preexisting Conditions in both Systems
The Japanese Universal healthcare system provides full coverage to all manner of medical complications, including preexisting conditions without discrimination.
On the other hand, the United States’ fragmented healthcare system, which is mostly dominated by private insurance providers, discriminated against patients suffering from preexisting conditions until the arrival of the ACA in 2010.
A3. Patient Financial implications
Patient financial implications in the two healthcare systems are evidenced by the differences in how the patient’s healthcare insurance premiums are funded in both countries. In the U.S, the government is involved in the payment of premiums for three categories of health insurance: Medicaid, Medicare, and state or federal employees’ medical covers. Premiums for Medicaid are paid through the tax-payers while those of Medicare are paid through payroll taxes. Premiums for private insurance are paid through co-sharing between the employers and the employees. Private and unemployed individuals that do not qualify Medicare and Medicaid pay for their premiums on their own individual efforts. These are often costly.
In Japan, the government pays for a greater percentage of thepremiums for universal public healthcare insurance, especially for low-income citizens. This is a little bit different from the likes of Medicare and Medicaid, where the government fully settles the premiums. The Japanese government determines the percentage of the premium to pay for each and every citizen and uses parameters such as household size, income, and assets owned to come up with the percentage. The government also requires the employers to fund half of their employees’ premiums as the employees also contribute up to ten percent of their salary.
References
Griffith, K., Evans, L., & Born, J. (2017). The Affordable Care Act reduced socioeconomic disparities in health care access. Health Affairs, 36(8), 1503-1510.
Niles, N. J. (2019). Basics of the US health care system. Jones & Bartlett Learning.
Zaitsu, T., Saito, T., & Kawaguchi, Y. (2018, September). The oral healthcare system in Japan. In Healthcare (Vol. 6, No. 3, p. 79). Multidisciplinary Digital Publishing Institute