C489 TASK 3 pocket. Prescription medications in Germany are nearly always covered. These amounts are fixed by the law and the cost for patients range between five and ten euros (Institute for Quality and Efficiency in Health Care, 2015). Those under the age of 18 are not responsible for these copays. A2b. In the United States, the need for a referral is based on the insurance plan. Some insurance plans require a referral to see a specialist while other plans do not. If a referral is needed, one must see their primary doctor to get the referral. The primary doctor and specialist both need to be in the network of preferred physicians in order to have coverage by the health insurance plan. If the plan does not require a referral, the patient may see any specialist that participates with the insurance plan. In Germany, patients are not required to see their primary doctor before seeing a specialist. If you are to be hospitalized in Germany, a referral will be needed to a specialist located in the hospital (Ridic, Gleason, & Ridic, 2012). A2c. According to the Secretary & Assistant Secretary for Public Affairs (ASPA), health insurance companies can’t refuse coverage or charge more for coverage due to a pre-existing condition (2017). This rule went into effect at the beginning of 2014 and the only exception is grandfathered plans (ASPA, 2017). Grandfathered plans are plans bought on or before March 23, 2010 that haven’t been changed in certain ways (ASPA, 2017). The private health insurance premiums in Germany for people with pre-existing conditions are often higher (Institute for Quality and Efficiency in Health Care, 2015). A3. 4
C489 TASK 3 The financial implications for patients in Germany compared with the United States can be far less. In Germany, everyone gets the same health care with the sickness funds. There aren’t any deductibles that need to be met with these plans. There are copays only. The cost sharing for patients is minimal (Ridic, Gleason, & Ridic, 2012). There are
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- Spring '16
- Universal health care , C806 Task 3