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Free «Healthcare Financing: The US and Japan» UK Essay Paper

Free «Healthcare Financing: The US and Japan» UK Essay Paper

Introduction

Arguments about appropriate access to the healthcare service in the US actively arise. Nowadays, the need for socioeconomic policy reforms just as the affordable and quality healthcare is discussed through the global media. While other developed states have experienced great changes to improve access and funding of medical treatment, the Japanese system is one of the best ones and more preferred in comparison to the US. Japan has a unique healthcare policy model that is more reliable and cheaper unlike the US. Hence, while Japan has the mandatory and universal on-job healthcare insurance system, the US utilizes the hybrid system that is rather more expensive and complex than in Japan. Therefore, the healthcare system in Japan is one of the cheapest among the industrialized countries and more efficient by contrast to the US.

Comparison of Access between the Two Healthcare Systems

In the US, children have access to healthcare due to the federal and local government support. According to the new American regulations for Medicaid in the State Children’s Health Insurance Program, the states are able to extend health insurance to kids of the parents that do not have insurance. The access to the medical services is based on the Patient Protection and Affordable Care Act. The latter claims that insurers are required to cover preventive services, extend coverage to children with existing medical conditions and cover young adults up to 26 years old by their parents’ plans (Centers for Disease Control and Prevention, 2017). Medicaid is the federal program that represents health insurance coverage to low-income Americans that involve juveniles under eighteen. The Children’s Health Insurance Program is the structural part of the Medicaid that provides insurance to juveniles under nineteen (Centers for Disease Control and Prevention, 2017). Hence, children are supported by available medical services.

In addition, the elderly and the unemployed have access to healthcare. The Affordable Care Act and Medicare offers insurance to senior people, particularly, those who retired. Medicare provides additional preventative care benefits. Moreover, the law raises the number of balances and check to ensure the best practices in nursing homes so that the elderly were more assured in the care quality. If the person is retired before sixty-five and the job-based health plan is no more available, there is an opportunity to use Health Insurance Marketplace to buy it. Thus, once people are 65 they are entitled to Medicare programs. Furthermore, the unemployed have an opportunity to receive health insurance in compliance with the Consolidate Omnibus Budget Reconciliation Act (COBRA) (Centers for Disease Control and Prevention, 2017). Even though it is possible, to apply for Medicaid, there are many eligibility demands. Therefore, the unemployed and retired people are provided with the available healthcare services, but for the former, this procedure is more complex.

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In Japan, children, the unemployed and seniors access healthcare through the National Health Insurance (NHI) system that is supported by taxes from NHI members, while in the US people are supported by the federal and local government. With regard to the proportion of medical costs that are paid, the preschool infants gain eighty percent, individuals ranging from the school-age to sixty-nine years old receive seventy percent and the amount for adults whose age varies from seventy to seventy-four reaches ninety percent (WHO & Ministry of Health, Labour and Welfare, 2012). At the same time, copayment for preschool infants is twenty percent, for those of school-age up to sixty-nine year-old adults it is thirty percent, for seniors aged from seventy to seventy-four it is ten percent, while the unemployed have to pay twenty percent (WHO & Ministry of Health, Labour and Welfare, 2012). In general, patients have free access to the provided medical services at any time. The fees are set by the government committees. As the law stands, all the Japanese are required to have health insurance coverage, while uninsured people are able to engage in the NHI program promoted by the local government. Therefore, both states adopted the healthcare policy, which ensures appropriate access to healthcare for juveniles, seniors and the unemployed. However, in Japan it is offered through cost sharing, while in the US the same social groups rely on the coverage from the federal and local government.

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Coverage for Medications

In the US, the medical coverage is provided by the insurance. Health plans are aimed at assisting in paying the cost for the prescribed medications. It is possible to buy other pharmaceuticals, but medications approved by the plan will be less expensive. Medicare helps the patient to gain some medication coverage (MedlinePlus, n.d.). Thus, this is an insurance, which creates the opportunity to pay for prescribed medications. Moreover, this insurance protects patients from paying high medical costs or settling unexpected prescription bills. Nevertheless, it does not cover all expenses and one has to pay additional monthly costs. Private organizations give Medicare prescription medication coverage, and an individual has to choose the most appropriate drug plan (MedlinePlus, n.d.). Therefore, despite the insurance coverage, the costs for medications are covered only partly.

Similarly, the coverage of medications in Japan is also supported by the insurance. In Japan, “under the universal health insurance coverage, the uniform fee schedule that the government determines regulates the price for all medical procedures and drugs” (Arnquist, 2009). In case the copayments are met, there is a principle of free access to pharmaceuticals. By contrast to the US, where doctors can decide the prices they charge, in Japan these issues are regulated by the state. Consequently, due to the mandatory healthcare insurance coverage, in Japan access to medications is less restricted and more reliable in comparison to the US.

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Requirements to Get a Referral to See a Specialist

In the US referral letter has several requirements in order to provide patients with specialist. In general, referral is the written order from primary care doctor for a person to see the professional or use specific medical services. Commonly one needs to get a referral before receiving medical care from anyone except the general practitioner. In the US, the referral letter has to be drafted, signed and dated by the physician, if it is not the emergency case. The referral is valid for a single treatment course for a period of twelve months after the first therapy is offered according to the referral (TMR Staff, 2016). Nonetheless, there is a possibility for healthcare staff to indicate another period of time. Moreover, the medical worker has to supply the specialist with all crucial information about patient’s health. Hence, the essential elements of the referral are date, form and signature.

At the same time, in Japan there is no such a need in the referral, unlike the US. In Japan, the patients are free to visit any medical facility type according to their preferences and no referrals are required for them to approach specialized or major hospitals. However, in this case, they have to pay the additional fee without referrals. The main point is that doctors can give the patient the later reference to the particular professional (Nagoya International Center, n.d.). However, if the person visits the large clinics without a referral letter, which will be priced at about two thousand yen, he/she has to pay from one thousand to three thousand yen for the first visit (Nagoya International Center, n.d.). In Japan, the healthcare provider has to write and sign the referral letter and including the type of disorder and cost. Therefore, in both states, the general practitioners have to prepare the referral letter for the specialist to consult the patient. The procedure demands the latter to visit the insurance company in order to confirm that the availability of coverage and verify whether the patient approaches the correct specialist for the particular health issue.

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Coverage for Preexisting Conditions

In the US, pre-exciting condition has to be covered according to the law. American health insurance companies cannot deny coverage for an individual or charge more just because one has pre-existing conditions (HHS, 2017). The main point is that health insurers can no longer refuse fro, coverage of the person or his/her child due to the pre-existing diseases such as cancer, diabetes or asthma. They are not able to deprive the patients of benefits for the condition (HHS, 2017). In case one has an insurance, he or she cannot be denied in the treatment covering for the pre-existing disorder. However, this rule has an exception because it cannot be applied to the “grandfathered” individual health insurance policies, when people bought insurance for themselves of for their families on or before March 23, 2010 (HHS, 2017). Hence, these issues have to be regarded. Nowadays, due to the Affordable Care Act people with the health insurance plan cannot be refused in the coverage of pre-existing conditions.

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At the same time, in Japan the healthcare insurer must also cover the pre-existing diseases. The situation in Japan is simpler owing to the mandatory insurance that covers pre-existing conditions. Thus, in the US, there were some difficulties with denying patients in the coverage of pre-existing disorders; nevertheless, in Japan, such issues never occurred and these matters were considered from the beginning. It means that despite the consideration of these problems from the legal perspective, the Japanese healthcare is more flexible concerning similar possibilities. Therefore, healthcare systems in the US and Japan have the legal background that makes insurance firms to propose coverage for pre-existing conditions. Hence, healthcare systems in both countries comply with the legislation that obligated insurance companies to offer the coverage for pre-existing conditions.

Financial Implications for Patients

In the US, health insurance is more expensive, and employed people have to pay private insurers three or four times of each worker’s amounts. Nonetheless, the self-employed citizens in Japan pay costly health insurance annually. The patients of the working age have to provide the co-payment insurance of thirty percent for the coverage of treatment and drugs (WHO & Ministry of Health, Labour and Welfare, 2012). Besides, these payments give the unemployed, juniors and the elderly necessary access to healthcare. Moreover, the medication coverage is more efficient in Japan, because in the US, there is only a partial coverage of medications. Despite the aforementioned differences, the choice of a physician is also in the patient’s hands. Additionally, the insurance companies are responsible for all referrals. In general, the healthcare financing system in Japan is cheaper and more flexible by contrast to the US.

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Conclusion

Overall, the Japanese and the US healthcare systems are quite similar, but still the Japanese healthcare system is more flexible and more affordable than the American one. Each state is believed to be the healthcare insurance and policy leader. Nonetheless, if to compare these healthcare systems it is possible to notice that Japanese healthcare is simpler, cheaper and more efficient than the US healthcare system. Through the given analysis, it is possible to understand what one can be learn from the Japanese healthcare system in order to improve the American medical services. Hence, the provided research is highly crucial because it explains in which ways exactly the Japanese healthcare system is more preferred than the one in the US.

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