Now an EPO or PPO insurance plan does not require a referral because it has a variety of doctorsthat may be seen at the patient’s discretion. If you are on a government program such as Medicaid or Medicare, a referral is not required to obtain treatment deemed necessary by your primary care physician. A2C. Coverage for Preexisting ConditionsEveryone must have good quality medical care in Japan. It is enforced and regulated by the government. It covers medical, dental, and prescription drug needs and a person cannot be denied regardless of preexisting conditions. The US has omitted their strict policies about providing insurance to patients with preexisting conditions. Under current law, health insurance companies can’t refuse to cover you or charge you more just because you have a “pre-existing condition” — that is, a health problem you had before the date that new health coverage starts (USDHHS, 2017). This allows the opportunity for everyone to have access to healthcare coverage.Updated on 6/15/2018
ORGANIZATIONAL SYSTEMS TASK 3 5A3. Finance Implications for Healthcare DeliveryTwo financial implications for patients regarding the healthcare delivery system in Japan are out of pocket spending and a safety net. The patients in Japan will obtain healthcare at any means necessary as imposed by the government. Each patient will pay at the most 30% of their medical, dental, and /or prescription drug costs. If you fail to maintain insurance, then you will be required to pay for two years up front. The safety net stipulates an out of pocket monthly medical expense for the population, which is based off your age and income. For example, there is a ceiling for low-income people, who do not pay more than JPY35,400(USD337) a month; and, subsidies (mostly restricted to low-income households) are in place to reduce the burden of cost-sharing for people with disabilities, mental illnesses, and specified chronic conditions (Matsuda, 2017). The financial impact to the citizens of the United States are cost sharing and out of pocket cost. Cost sharing varies amongst the states and insurance providers; and, it normally has a copay attached to it for doctor visits and prescription drugs. 57 percent of people who selected plans in the federally facilitated marketplaces had cost-sharing subsidies (Osborn, R. and Sarnak, A., 2017). Out of pocket expenses varies depending on the type of healthcare coverage you may be enrolled in. You may have a deductible that has to be met before the insurance provider pays anything on your behalf.
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- Spring '19