(PPOs) allow patients broader and direct access. Access to specialists can be difficult for Medicaid beneficiaries and the uninsured, because some specialists refuse to accept Medicaid
RUNNING HEAD: Organizational Systems 4 patients due to low reimbursement rates. People can wait weeks or even months before getting in to see a specialist (“ The Commonwealth Fund” ). Japan’s healthcare has a stark contrast in specialist referrals. People do not have to be referred by their primary care and they are not limited as to which specialist they can see by their healthcare plan. An appointment is not necessary either as people can just walk in to the office and be seen therefore wait times are drastically different (PBS, 2017). A2C. Coverage for Preexisting Conditions Under current law, health insurances in the U.S. cannot refuse to cover or charge more due to a pre-existing condition—that is a health problem a person had before the start of health coverage. Nor can companies limit benefits regarding that condition (“ U.S. Department of Health & Human Services, 2017” ). Similarly, Japan’s healthcare system cannot refuse or charge a person more if they have a pre-existing condition. Health services and medications are covered by NHI (PBS, 2017). A3. Finance Implications for Healthcare Delivery One financial implication for patients in the U.S. is that hundreds of thousands go into bankruptcy due to medical bills. The United States has the most expensive medical system in the world. Many people cannot afford to pay what their health insurance does not cover. Americans spend two times more on medical expenses than other industrialized countries. Another implication is that it is estimated that 47 million people do not have coverage and are therefore left to pay medical bills out-of-pocket or chose not to receive medical services. Americans now face a fee during income tax if they do not have health insurance (PBS, 2017).
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- Fall '18