In Japan all citizens regardless of age, employment status, or the unfortunate poor have insurance compared to millions of citizens in the United States who have no coverage. A2A. Coverage of Medications
ORGANIZATIONAL SYSTEMS AND QUALITY LEADERSHIP3The United States supports a free market system where drug prices are significantly higher compared to the rest of the world. Coverage of medications in the states is determined by the insurance company. Insurance companies may deny medications that are novel, may require failure of multiple medications before approving a new medication, and may only cover generic meds. Prices are not fixed in the United States and citizens will pay fluctuating amounts for prescriptions depending on where they choose to fill them and what insurance product they are covered under. Copay cards from drug companies may help to offset out of pocket costs for consumers with commercial insurance, but these types of savings do not apply to those with Medicare or Medicaid. On the opposite end of the spectrum, prices for medications and procedures in Japan are set at a fixed amount that is non-negotiable once set. These prices are determined every two years by general practitioners and the local health ministry (Reid & Palfreman, 2008). Japanese citizens find that medications and procedures are extremely affordable compared to that of the United States because of this fixed pricing. As noted by Reid, wherever a citizen decides to purchase medications, undergo a procedure, or receive care in the country of Japan, the cost will be the same. A2B. Referral to See a SpecialistIn order to see a specialist in the United States, a referral from a primary care physician or another provider is usually needed. Authorization and review of necessity by the insurer may approve or deny coverage for the referral depending on the insurer. It is very unlikely that a
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- Spring '17
- Universal health care