A2a. Coverage of Medications There is a large difference in comparing Japan with the United States related to procedures and medication costs. In Japan, prices for every procedure and drug are negotiated every two years between the physicians and the government. The prices are fixed and the same regardless of where you go in Japan for treatment (Reid, 2008). In the United States, different healthcare plans offer a variety of coverage for medications but some prescriptions can be denied by the insurance company based on your type of insurance plan. Drug companies are very competitive in the United States and prices are expensive. Frequently, insurance companies might cover a similar or generic form of medication rather than the brand name medication and insurance co-pays differ depending on which drug is prescribed. A2b. Referral to See a Specialist How hard is it to get a referral for a specialist? Japanese citizens do not need a referral to see a particular specialist. There is not a gatekeeper, so therefore, Japanese do not need a referral and also do not need an appointment. Any individual can walk into any doctor’s office and be treated (Reid, 2008) In the United States, most insurance companies require referrals to see a specialist from a primary physician or any emergency room physician can give referral as well, but some specialist can be seen without a referral. Some health insurances require pre-authorization to see a specialist to deem whether or not the referral is needed. Also in contrast with Japan, Americans do have to make appointments with specialist
and at times appointments have to be made weeks or months in advance depending on the particular specialist needed. A2c. Coverage for Preexisting Conditions In Japan, it is forbidden for an individual to be denied insurance based on a preexisting condition (Reid, 2008). In the United States, insurance plans obtained after 2010 cannot deny coverage based on pre-
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