insurance plan on the marketplace and qualify for lower priced premiums and out of pocket cost based on household size and income (Healthcare.gov). Some retirees in the US also have private insurance as well as retirement insurance provided by employers. Updated on 6/15/2018
ORGANIZATIONAL SYSTEMS TASK 3 5 A2A. Coverage of Medications Coverage for medication in the U.S. is provided by specific insurance providers. Depending on the insurance provider, residents of the United States can obtain certain medications from specified pharmacies. The medications on the approved list are usually more affordable. According to the CDC, National Health Survey Interview, unemployment was associated with reduced access to needed prescription drugs due to cost. In the same survey, it is also noted that adults without health insurance, both employed and unemployed, were more than twice as likely to not get needed prescription drugs because they could not afford them as those with either public or private insurance (CDC, 2009-2010) In contrast to the United States, access to medication in Japan is included in the universal health plan coverages. Although Japan continue to use traditional herbal remedies, some physicians do provide a small variety of medication from the office. Although there are very few, pharmacies in Japan can provide medications as well. However foreign medications are not available in Japan and visitors are encouraged to bring necessary medication with them. The SHIS plans that are mandated, covers all approved prescription drugs in Japan. A2B. Referral to See a Specialist Japan’s Universal Health Care is very inclusive of all physicians regardless of the care they provide. There are not gatekeepers in Japan regulated the provision to see any specific physician despite the specialty. Residents of Japan are allowed to visit any hospital or clinic without the need of a referral to see a specialist. While some specialists are in outpatient hospitals settings, others are found in clinics. The hospitals and clinics in Japan are independently owned and operated by private physicians, local governments or public agencies. Updated on 6/15/2018
ORGANIZATIONAL SYSTEMS TASK 3 6 The SHIS provides coverage for this specialty care with the same cost-sharing stipulations of a 30% copay. Obtaining a referral for a specialist in the United States is dependent of insurance type. A referral is basically a written script provided by the primary care physician to see a different physician that specialized in a specific field within the same network. There are several different types of healthcare insurance plans in the US that require either a written script or a phone call to see a specialist. Members with HMOs or POS insurances must have a referral provided by their primary care physician before seeing a specialist. These two insurance plans require that members are seen by “in-network” providers only. HMOs do not cover any out-of-pocket
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- Spring '19
- Organizational Systems Task