C489 Task 3 - Task 3 PDF

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Task 3...

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Healthcare Financing

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Organizational Systems and Quality Leadership Task 3 Western Governors University

Healthcare Financing

2 Healthcare Financing A:

The country whose healthcare system that will be compared to the United States is Japan. Japan has one of the best healthcare systems in the world. A2: In Japan, access to receiving healthcare is easy. Everyone including, children, unemployed, and retirees are covered by signing up for a health insurance policy through either an employer or through the government. Japanese residents are responsible for paying 30% of their healthcare cost. The Japanese government pays for the other 70% of healthcare costs related to appointments. Depending on the patient’s income, that ratio may change to favor the patient. The elderly and children have decreased coinsurance rates. There is also a maximum yearly family payment for long-term care and health care services. This is based on age and income (Matsuda, 2020). In the United States, there are multiple ways to obtain health insurance. Most of the individuals obtain health insurance through their place of employment or pay for private insurance (Cherry & Jacob, 2019). Private health insurance premiums are extremely costly, and often not affordable. There are many individuals who do not health insurance due to the cost, and are required to pay out of pocket for these expenses. Children are insured through their parent’s insurance. Depending on income, children can also be insured through government programs. Government program such as Medicaid, offers health insurance for unemployed individuals and children. Eligibility for the program is income based. Americans who are retired are eligible to receive health insurance through the government through a program called Medicare. This program requires individuals to be 65 or older to be eligible. The Parent Protection and

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Healthcare Financing Affordable Care Act are more options for health insurance. The U.S military covers the families of active-duty soldiers as well as the solider themselves with a program called Tri-Care (Cherry & Jacob, 2019). A2A: The Statutory Health Insurance System (SHIS) has many benefits. One of those benefits includes approved prescription medications (Matsuda, 2020). Those policyholders who have SHIS, are required to pay 30% coinsurance for medications and health services. There are no deductibles that need to be met, but there are coinsurance and co-payments. The government regulates the fees. All Japanese residents have coverage for all needed medications (Matsuda, 2020). In the United States, the coverage for medications is much different than that of Japan. All Americans should have the ability to obtain any needed medication, but the ability to pay for the medications is different for each individual. For individuals who have health insurance, most of the cost of the medication is covered except for a co-payment (Cherry & Jacob, 2019). If an individual’s insurance does not cover the medication or the individual does not have insurance at all, they are responsible for covering the cost of the medication out of pocket. There are many pharmacies who have common prescription medications at a lower rate to allow individuals to obtain those needed medications (Cherry & Jacob, 2019). A2B: Japan does not require referrals to see specialists (Matsuda, 2020). Many insurance companies in the United States do not require referrals for specialists. If an American has a Preferred Provider Organization plan, those individuals typically do not require to obtain a referral to a specialist. It is recommended that the individual use a provider in the network to

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Healthcare Financing avoid paying high copayments. Those individuals who have a Health Maintenance Organization plan do typically need to obtain a referral to see a specialist (Cherry & Jacob, 2019). A2C: Since Japan has universal healthcare, each resident’s health insurance is covered. No

matter their age, income, or if they have pre-existing conditions, it does not affect the availability of healthcare (Matsuda, 2020). From 2010 and after, pre-existing conditions are no longer a factor in the insurance coverage of Americans. Due to the Affordable Care Act, insurance companies can no longer use pre-existing conditions to deny or charge higher premiums (Cherry & Jacob, 2019). A3: Healthcare is provided for every individual in Japan. Healthcare is paid for with individual contributions and taxes (Matsuda, 2020). Due to the use of taxes, this increases the taxes for the employed and has an impact on the delivery of healthcare. The SHIH coinsurance rates are another impact on the healthcare in Japan. For most of the residents of Japan, the coinsurance is 30%. Both the elderly and children are exempt from this coinsurance. For many Japanese residents, this coinsurance can become costly (Matsuda, 2020). In the United States, the cost of healthcare is very high. One financial impact on Americans is that insurance companies can regulate the cost of health insurance for individuals (Cherry & Jacob, 2019). This means that an individual who has many underlying conditions, or lives an unhealthy lifestyle would have their insurance cost more than an individual who has very minimal health issues. Insurance companies also have the ability to deny a needed medication or medical procedure, causing the individual to be responsible for the cost. There are

Healthcare Financing times when hospitals discharge individuals too early, causing a readmission. There have been many initiatives to help reduce the rate of readmissions (Cherry & Jacob, 2019).

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Healthcare Financing

6 Reference:

Cherry, B., DNSc, MBA, RN, NEA-BC, & Jacob, S. R., PhD, MSN, RN. (2019). Contemporary Nursing (8th ed.). Elsevier. https://doi.org/https:wgu.vitalsource.com/#/books/9780323554206/cfi/6/40!/4/2/2@0:0 Matsuda, R. (2020, June 5). International Health Care System Profiles: Japan. www.commonwealthfund.org. Retrieved December 28, 2021, from https://commonwealthfund.org/international-health-policy-center/countries/japan...