Task 3 No Name - Organizational Systems and Quality Leadership Task 3 C489 PDF

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Organizational Systems and Quality Leadership Task 3 C489...

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Organizational Systems and Quality Leadership Task 3, SAT1-0517/1217

Western Governors University

ORGANIZATIONAL SYSTEMS TASK 3

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Healthcare Financing A1. Country to Compare Japan A1. Access Japan is an easy access healthcare system. Every individual, unemployed, child, and retired can sign up for healthcare coverage. The is work or community-based insurance. The government will provide insurance through social insurance. If a person becomes unemployed, they can switch over to a community-based insurance. A parent can apply for a child for a Free Medical Certificate for children provided by the city or ward in Japan. That will cover 70 percent of the medical costs and is valid until the child turns 15. Vaccination are not covered, but the parent can apply for it to be under the county or ward. A child in the US is covered if their parents have insurance through work or provided through a private insurance company. If the parent does not have insurance then the fees for the child are paid out of pocket. A parent can apply for medical assistance through Medicaid. But, Medicaid is only covered if the family meets the low income bracket. In Japan, the unemployed can get insurance through a community-based insurance. In the United Stated you are not covered once you are not employed. A person has to meet a lowincome bracket in order to receive government assistance. In Japan retired people under the age of 75 are covered under a community-based insurance. After the age of 75 the insurance changes to a social insurance where there is a

Updated on 2/21/19

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premium. If the individual cannot afford to pay the premium it is covered under the city or ward in which the individual resides. In the United States, after the age of 62 an individual can be eligible to receive Medicare. Not all costs are covered under this insurance and is sometimes used as a secondary insurance. Whether you have a private insurance or you have retired from the military and receive benefits that include coverage of healthcare for the remainder of the life of the individual that served in the Armed Forces. In the United States, healthcare can be covered by the employer. The cost of the insurance depends on the company a person works for and also the insurance company. A child can be covered under their parent work. If self employed, people have to find an insurance that is affordable for them. A private insurance can be very expensive. The is government assistance that is available like Medicaid and Medicare. A2A. Coverage of Medications In Japan, prices for procedures and medications are negotiated every two years between the government and the physicians. Prices stay the same after negotiation no matter where you live in the Country. In the United States it depends on your healthcare plan as to how medication is covered. Different healthcare plans offer different ways that medication is covered. It is based on the plan type. If you do not have health coverage or government assistance then the medication is paid out of pocket. There are many drug companies in the US. They can be competitive and pricey. More than likely there will be a generic for of the medication that the individual can receive that is at a lower cost than the brand name pharmaceutical.

Updated on 2/21/19

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In 2010, The Patient Protection and Affordable Care Act was signed into law in the United States. It was designed to enhance coverage for uninsured or low-income Americans. There was a lot of controversy when the PPACA was put into place since a large number of Americans felt like it was unconstitutional for the government to mandate that American citizens who were not insured by another source purchase this healthcare or otherwise have to pay a fine based on percent of income through yearly taxes. There are numerous insurance avenues for children, unemployed and the elderly in the United States; examples include, Medicare, Medicaid, private insurance companies, and Tricare which includes military personnel extending to their families (Cherry, 2014). Today in the United States you are not mandated to get insurance. However, there are many Americans who still go uninsured, while in Japan, every citizen is insured.

A2B. Referral to See a Specialist In Japan a person does not need a referral to go see a specialist. An individual, child, unemployed, or retired can see any physician that they feel will help them. In the United states, it depends on the insurance as far as if you can see a specialist. In an HMO, (Health Maintenance Organization) an individual can only see specialists in the network and has to have a referral based on what specialist to see in the network. Then there is a PPO (Preferred Provider Organization) that an individual can decide who they want to see without a referral as long as the insurance is covered in that specific facility.

Updated on 2/21/19

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If you are uninsured in the US you will probably need a referral in order to see a specialist. These costs are covered solely by the individual unless they have government assistance. This is the same if you are a child, unemployed or retired. A2C. Coverage for Preexisting Conditions Healthcare is available to every individual in Japan. Whether you are a child, unemployed, or retired, an individual can obtain insurance even if there is a preexisting condition. Health insurers can no longer charge more or deny coverage to you or your child because of a pre-existing health condition. They cannot limit benefits for that condition either. Once you have insurance, they cannot refuse to cover treatment for your pre-existing condition. If you do not have insurance and have a pre existing condition, a physician cannot refuse to see you according to the Affordable Healthcare Act. Yet, fees will have to be cover by the individual 100 percent instead of having a percentage covered by insurance. A3. Finance Implications for Healthcare Delivery In Japan, healthcare is mandatory. It has a healthcare that is based off of three categories. The categories are employer-based insurance, National Insurance, and insurance for the elderly. These insurance programs are financed mainly by the government and private employers. In the United States, providers are prohibited from charging extra fees except for some services specified by the Ministry of Health, Labor and Welfare (MHLW), including amenity beds, experimental treatments, the outpatient services of large multispecialty hospitals, afterhours services, and hospitalizations of 180 days or more. Safety net: Catastrophic coverage stipulates a monthly out-of-pocket threshold, which varies according to enrollee age. (International Commonwealth Act, 2017)

Updated on 2/21/19

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US Healthcare is one if the biggest and most complex healthcare systems in the world. The charges depend on the facility and the insurance coverage. An individual that does not have insurance or does not meet the criteria for assistance is responsible for 100 percent of the bill that is accrued while seeing a provider and receiving treatment or medications. Japanese Healthcare cost half as much as healthcare in the United States and has better medical outcomes. It is a straight forward healthcare system that has been known to aid in the cost, the longevity of people, and the overall well-being of the population.

Updated on 2/21/19

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Marylane, K. (2014). Paying for healthcare costs in America: Rising costs and challenges. Retrieved July 11, 2020, from https://wgu.vitalsource.com/#/books/9780323390224/cfi/6/40!/4/2/4/2@0:0://www.qualityindic ators.ahrq.gov/

International Commonwealth Fund (2017). International Profiles of Health Care Systems. Retrieved from https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications _fund_report_2017_may_mossialos_intl_profiles_v5.pdf

Updated on 2/21/19...