Task 3 C489.docx - Organizational Systems and Quality Leadership Task 3 Alicia Taylor Western Governors University ORGANIZATIONAL SYSTEMS TASK 3 2 A1

Task 3 C489.docx - Organizational Systems and Quality...

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Unformatted text preview: Organizational Systems and Quality Leadership Task 3 Alicia Taylor Western Governors University ORGANIZATIONAL SYSTEMS TASK 3 2 A1. Country to Compare I will be comparing United States healthcare system to Japan’s healthcare system to identify the difference in which the two provide healthcare and the healthcare finances of the country. A1. Access The United States Affordable Care Act (ACA) created an shared responsibility between the government, employers and individuals to ensure Americans have access to affordable and good health insurance [ CITATION Int17 \l 1033 ]. Different healthcare plans are offered by private insurance companies, employers, and available through government assistance programs depending on age, income, and immigration status. Children have access to healthcare coverage through their parent’s insurance or Children’s Health Insurance Program (CHIP) for low-income families. Unemployed residents have access to a government program called Medicaid given they meet all requirements. Retired residents are normally covered through their private insurance companies or Medicare government federal program for adults 65 and older [ CITATION Int17 \l 1033 ]. Japanese health care system is regulated by the government and is called universal Statutory Health Insurance System (SHIS) [ CITATION Int17 \l 1033 ]. The health insurance is divided into three insurance plans: employer-based health insurance, residence-based National Health Insurance (NHI), and health insurance for persons over 75. It is mandatory for Japanese citizens to enroll in one of the SHIS plans and have no choice of health insurance programs. The plans are assigned the based-on age, employment status, and residence. If the citizen is not head of house hold and not eligible through employer, then the plan is assigned based on the head of house hold status[ CITATION JHP15 \l 1033 ]. Undocumented immigrants and visitors are not ORGANIZATIONAL SYSTEMS TASK 3 3 covered under the SHIS plans. Citizens and non-Japanese citizens age 40 and over that are enrolled into SHIS are mandatorily enrolled in long-term care insurance. NHI plans are accessible to unemployed and retired citizens under 75. Children are either covered under the parent’s employer-based insurance or NHI. Comparing United States Insurance access to Japan Insurance access, United States have a less mandatory approach to the choice of insurance plans and Japanese is a mandatory system that do not offer the opportunity for citizens to shop around for plans. Both countries offer insurance to children in similar ways but retired citizens in Japan would need to apply for coverage before age 75. Overall, Japan mandatory approach ensures that all citizens will have insurance coverage versus the United States gives the option for people the choice to go without health insurance. A2A. Coverage of Medications United States ACA requires all health plans to cover prescription drugs but depending on the type of insurance coverage there may be a copayment due for medications or residents receiving government health coverage may have zero or reduce special cost for medications. Japan citizens are required to pay a 30 percent coinsurance for services and goods which medications are covered in this cost. Children up to age 6, adults 70 to 74 with low incomes and age 75 and older with low incomes are not required to cover the 30 percent [ CITATION Int17 \l 1033 ]. After reviewing both United States and Japan coverage for medication, it shows a big difference in how each country provides coverage for the cost of medications. United States residents’ cost for medication could be high or low depending on the medication cost and the copayment they are required to pay. Most low-income families in the United States medications ORGANIZATIONAL SYSTEMS TASK 3 4 are paid in full by the insurance or fixed low coverage fee depending on the government coverage. Japan citizens pays a 30 percent for all charges that are not included in what is covered by the insurance company which also covers fees for the medication cost. A2B. Referral to See a Specialist United States residents are required to receive a referral by a primary care doctor to see a specialist and their choice of specialist are limited under plans some plans like HMOs. PPOs plans allow residents direct access to see a specialist but residents covered under Medicaid and uninsured residents will have difficult time seeing a specialist because some refuse to accept Medicaid due to fear of residents owing low reimbursement rates [ CITATION Int17 \l 1033 ]. Most Japan specialist care is provided in a hospital outpatient setting, but also in clinics which makes it easy for citizens to be seen by the specialist without the need for a referral. Specialist fees are the same as a primary care visit fee and there are no regulations on payments for specialists and hospital specialists are salary[ CITATION Int17 \l 1033 ]. Japan offers an easier way to be seen by a specialist versus the United States residents can only be seen if referred by a primary care physician. Japan also pays specialist salary which is the opposite of the United States specialist are paid on a negotiated set fee schedule. A2C. Coverage for Preexisting Conditions According to [ CITATION USD20 \l 1033 ], under the Affordable Care Act of 2014, health insurance companies are not allowed to refuse to cover or charge a increased rate due to preexisting conditions. Most private insurance coverage sold by insurance companies, agents, or brokers on or before March 2010 may not follow some of the rules under the Affordable Care Act. ORGANIZATIONAL SYSTEMS TASK 3 5 Japanese health system offers health coverage for all citizens with preexisting conditions and citizens can not be denied due to the preexisting condition. Comparing both countries information shows both honor the need for coverage regardless of a preexisting condition and they ensure companies are unable to deny for that reason. Japan preexisting conditions are a minimal concern due to the mandatory requirement to have health coverage from the start of birth. A3. Finance Implications for Healthcare Delivery The one financial implication I would like to discuss is deductible and copay cost for insurance coverage. In Japan citizens are required to cover 30 percent and 10 percent for elderly citizens for service which includes visits, medical equipment, and medication, but the United States residents are being burden with high deductibles of a minimal annual cost of 1,250 per individual or 2,500 per family. Due to this high deductible in the United States this leaves a lot of families in debt from medical bills and left with the decision to file bankruptcy. Japan has no history of citizens struggling with medical bills due to the affordable copay cost. The second financial implication I would like to discuss is medication cost. Most United States insurance plans have deductibles which could lower medication cost for most residents, but uninsured residents are left with the responsibility of paying full cost for medications that are needed for many critical conditions such as cancer, diabetes, and hypertension. This could cause the resident to have the increase burden of choosing which medication to purchase or simple not purchase any of the medications needed. This increases the risk for the resident to have more health problems and admission to the hospital which could be another medical cost expense. Japan health care system mandated citizens to have health care coverage to reduce the risk of having uninsured citizens and the coverage is at an affordable rate of 30 percent which ORGANIZATIONAL SYSTEMS TASK 3 6 covers the cost of medications. Japan also review the cost of coverage and generic brand medicine yearly to maintain cost affordable for the citizens. Comparing the two it shows Japanese citizens are less likely to have financial hardship due to medical bills and medication cost versus the United States residents are having to file bankruptcy due to the high amount of medical bills and often are without medication due to high cost or lack of health care coverage. ORGANIZATIONAL SYSTEMS TASK 3 7 References International Profiles of Health Care Systems. (2017, May). International Profiles of Health Care Systems. Retrieved from Common Wealth Fund: JHPN. (2015, April). Retrieved from Japan Health Policy NOW: U.S. Department of Health & Human Services . (2020, April). Retrieved from hhs.gov: ...
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