For anyone who has private health insurance usually the owner of the policy or guarantor and their spouse and any dependent are eligible for that policy as long as they are enrolled. People who are unemployed, children of people who are unemployed, children in the foster care system, and people with disabilities all have access to the public health care. This includes Medicaid, Medicare, and CHIP. Retired citizens and citizens over the age of 65 are eligible for Medicare. Unfortunately, illegal immigrants are not eligible for public healthcare, but a vast majority of hospitals who get Medicare funds must provide care to any patient with an emergency condition to get them stabilized. There are just so many plans and coverages that it is hard to know each plan and program available.When looking at similarities in coverage and facilities I looked at Primary Care and Hospitals. Primary care in both countries is private or mostly private and the only difference is that in England it is required that you have a family physician and in the United States it is not required. As for hospitals, in both countries they are mostly public (England) or Non- Profit (US). There are a few private and public for profit hospitals in both countries.a.Discuss coverage for medications in the two healthcare systems.When looking at the coverage for medications between the 2 healthcare systems, Ifeel that England has the right idea.In England, medications that are prescribed in an NHS hospital are free. Medications that are prescribed by a specialist, primary care provider, or other outpatient physician are subject to a copayment that is roughly $12.14 US dollars for each prescribed item. For patients/people in England who need a large amount of one medication or large amounts of different medications, they can purchase a voucher (or prepayment certificates as they call them) for either 3 months or 12 months. The cost for a 3-month certificate is approximately $42.00 US dollars and the cost for a 12-month certificate is approximately $150.00 US dollars. With these certificates, the owner does not incur any further charges for the length of the voucher, no matter how many prescriptions they have. Approximately 90% of prescriptions were dispensed for free in 2015. Along with the vouchers that patients can pay for there are several groups of people who are exempt from paying the prescription copayments. These groups are children under the age of 15; children ages 16 – 18 who are in school full time; individuals and families with a low income; people who are 60 and over; people who have chronic (long term) medical conditions or certain disabilities; people who have cancer; and women who are pregnant or have given birth within the past 12 months. Unfortunately, it is not as simple in the United States. The Affordable Care Act orACA states that all health plans in the insurance market must cover essential health benefits in 10 categories, one of which includes prescriptions. It is then up to each state to decide on the extent or range of what is covered by looking at the benchmarks that each plan covers. Just because plans cover prescriptions and medications does not mean
that the individual will not have to pay for their medications.
- Fall '17