Coverage of Medications In the United States, health plans will help pay the cost of certain prescription medications. The US Citizens may be able to buy other medications, but medications on their plan’s “formulary list” (approved) usually will be less expensive for them. In Germany, prescription drugs are nearly always covered. “The out-of-pocket costs for prescribed drugs range between five and ten euros, depending on their price. Children under the age of 18 do not have to pay these additional costs. Again, both countries have entirely different outlooks on how they manage health care” (Miriam Blümel, 2016). Referral to See a Specialist If someone plans to see a United States physician specialist (e.g., Cardiologist, Psychiatrist, Rheumatologist, etc.), in most cases, they will be referred by their primary health care provider. However, in Germany it is not uncommon to make an appointment directly with a specialist without being referred to a primary health care provider first (B.V., 2019). As with primary health providers, German specialists operate in both private and state-run sectors, and an individual will need either state-funded or private health insurance to cover all treatment(s). Depending on the specialist treatment required, a person typically has to wait days or even several weeks just to receive an appointment under the public system (B.V., 2019). However, in the United States, a person would need a written referral/order from their primary health provider for them to see a specialist or to get certain medical services. In many Health Maintenance Organizations (HMOs), they need to get a referral before they can receive medical treatment from anyone except their primary care doctor.
TASK 3: HEALTHCARE FINANCING 6 Coverage for Preexisting Conditions Unlike the United States, Germany does not frown upon individuals for having pre- existing conditions when trying to access their health care system. If a person has any known conditions and has private coverage insurance, their premiums may be at an increased rate. Legally, they have to accept anyone, so people will not be denied health coverage because of their pre-existing conditions. According to HHS.gov: Health insurers in the United States can no longer charge higher rates or deny coverages to insured payers or their child due to a preexisting health condition such as asthma, high blood pressure, diabetes, or cancer. They also cannot limit benefits for that condition either. Once individuals have insurance, they cannot refuse to cover treatment for their preexisting condition(s) (U. S. D. o. H. H. Services, 2017). Finance Implications for Healthcare Delivery According to Healthaffairs.org: Germany's health care system is almost perfect with being very simple. Germany seems to have an understanding of operational simplicity of a smooth system as well as its fairness & efficiency of all the particulars. Perhaps, Germany and the leaders who represent the country take pride in having such a simple setup while making health care laws simple for their residents. The lawmakers in Germany's parliamentary system seem to make it very simple to create, govern, and implement solid policies; including cost control programs; without the multitude of different addendums that frequently complicate our US public rule. This has become obvious in the public
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