Medicare offers supplementary prescription coverage which is available for additional fees.
In Japan approved prescription medications are included in the SHIS. The Central Social Insurance Medical Counsel sets the drug list for SHIS which is set based on clinical effectiveness as opposed to cost (TJHCS). Fees are based on current prices but are set and revised to meet spending targets. Referral Requirements:Seeing a specialist and referral requirements in the U.S. is dependent on the type of insurance the participant has. Some insurances such as health maintenance organizations (HMO) require the participant to be referred by their primary care physician that acts as a gate keeper and must submit a request to the insurance company for the referral to be approved andmay be limited to plan participating doctors (USHCS,2016). Preferred provider programs or PPO’s participants can self-refer to specialists though generally they will require a higher co-pay than primary doctors. Participants of public programs such as Medicaid may have difficulty seeing a specialist due to limited providers participating in the plan as reimbursements rates arelow (USHCS, 2016).In Japan citizens can see a specialist without any type of referral. The specialists are paidbased on the same schedule as primary doctors however some procedures must be performed by the specialist (TJHCS).Pre-Existing Conditions:Under the current laws in the U.S. insurance companies cannot refuse coverage for pre-existing conditions. The participant also cannot be charged a higher rate or have limited coverage based on a pre-existing condition.
Japans universal care system does not deny coverage to anyone with pre-existing conditions and since fees and medication fees are set by the government participants are not charged more either.
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- Spring '19
- Universal health care