How to write a nursing essay on Healthcare Financing solved

How to write a nursing essay on Healthcare Financing solved

Healthcare financing provides organizations with the economic incentives and resources for the operation of healthcare systems. Financing these systems is a key factor that determines performance in terms of equity, efficiency, and health outcomes. More than a decade since the Affordable Care Act (ACA) was passed, healthcare financing and other reforms remain atop priority for the US healthcare system (Shrank et al., 2021). Affordability of healthcare services still remain a challenge for many people both at the individual and system level. The growing population of uninsured people and recent catastrophes like Coronavirus disease 2019 (COVID- 19) have further exacerbated the shortcomings of healthcare financing (Shrank et al., 2021). This discussion compares healthcare financing in the US with other developed countries and the financial implications for patients.

A1. Country to Compare

The evolution of healthcare financing reveals a fundamental shift in core issues surrounding care delivery worldwide. Globalization is observed to affect the distribution of income both in rich and poor countries making healthcare financing a key issue. Other factors like unemployment and economic uncertainty have stressed many countries leading to limited access to healthcare services. Japan is among the developed countries whose healthcare system closely compares to the United States. Although the United States spends more capital on healthcare than any other developed country, Japan has performed better in terms of accessibility and affordability of healthcare services to the people. Because of the complexity of healthcare systems in these two countries, comparing healthcare financing can best explain the key differences observed.

 A2. Access

Healthcare access is the primary feature that enables people to get the required health services to achieve the best health outcomes. Access to healthcare is defined by four main components which include coverage, services, timeliness, and workforce. Coverage ensures the entry of people into the healthcare system and it is determined by the availability of health insurance across populations. In the United States, many people rely on public health insurance such as Medicaid with others opting for private plans. The diversity of populations under these programs contributes to the differences in healthcare access among children, the unemployed, and people who are retired.

The health of children depends partially on access to healthcare services. In the United States, more than 20 million children still lack sufficient access to essential healthcare due to various barriers (Children’s Hospital Association, 2021). Children in the US mainly receive access to healthcare through Children Health Fund (CHF), ACA, and Children Health Insurance Program (CHIP). These programs provide insurance cover to children with special needs and those from low-income families. Reports indicate that about 39% of children are covered by Medicaid while CHIP provides access to 9% of the children and pregnant women (Children’s Hospital Association, 2021). Another important issue is inequality, especially for marginalized communities. The existence of financial and non-financial barriers makes it difficult for children to access healthcare services. For example, over 13.1 million children experience difficulties paying their medical bills despite enrollment in insurance programs.

Japan has a National Health Insurance (NHI) program that deals with healthcare access for adults and children. NHI and social health insurance are both available for children making it easier to access essential services. For example, Japanese Health Insurance pays 70% of the total medical costs for children, and adults have to pay the rest (Japanese Healthcare Info, n.d.). For children, free medical care is available upon applying for a certificate from the city or ward. One key feature of Japanese children’s insurance is that it is valid until 15 years of age. The age limit can also vary depending on the city one lives and essential children’s services like vaccinations are not included in the insurance programs.

Unemployment is well-known to contribute to poor healthcare outcomes because of limited access to healthcare services. In the United States, unemployment is a limiting factor to healthcare access and the various insurance programs available do not seem to fully satisfy this population. The Federal-State Unemployment Insurance Program provides unemployment benefits to workers who are unemployed through no fault of their own (United States Department of Labor, 2022). However, these individuals must meet the State requirements for wages or time worked in a given period. Because most people do not meet the requirements, they are forced to purchase Medicaid insurance through the Marketplace. For families with children, CHIP provides coverage for up to 15 years and this may extend to pregnant women (United States Department of Labor, 2022). In Japan, the universal healthcare system provides insurance coverage to everybody including the unemployed, self-employed, and students.

The elderly aged 65 years and older represent a significant population in the US with nearly every individual turning 65 becoming eligible for Medicare. Individuals are eligible for premium-free Part A if they are 65 years or older and their spouses worked and paid taxes for at least years. All individuals retiring before the age of 65 are not eligible for Medicare and have to purchase private plans. Every state has a health insurance Marketplace where private plans can be purchased. The difference between the US and Japan regarding health insurance for the retired is minimal. While the US provides Medicare for all retired employees above the age of 65 years, Japan extends the age to include all individuals below 75 years. The universal healthcare system accommodates all individuals including those that retire prematurely due to healthcare problems or other reasons.

A2a. Coverage of Medications

In the United States, Medicare drug coverage helps pay for the prescription of drugs needed. This plan is optional and is offered to everyone with Medicare and those who fail to register are subject to a late penalty. For individuals to get drug coverage, they must join a Medicare-approved plan that offers drug coverage. These drug plans are divided into part A and part B with each plan having different types of medications covered. Another available alternative is the Medicare Advantage plan with drug coverage that provides coverage for certain medications. These plans also differ in cost depending on the types of drugs covered. For individuals who cannot afford these plans, private insurance plans, especially for those that are employed are available. Certain employer-sponsored Medicare health plans and private fee-for-service plans are also available to cater to prescribed medications.

Japan’s National Health Insurance system differs from the US Medicare and Medicaid system regarding coverage of medications. It is a common practice for physicians in Japan to prescribe drugs using their generic names to reduce the cost of medication. Overall, NHI covers 70% of all medical costs including drugs and the individual is required to cater for the remaining 30% (Tikkanen et al., 2020). To ensure prescriptions are not misused, a grace period of four days is allowed for patients to fill their prescriptions. Almost every pharmacy in Japan dispenses drugs at the same price and the use of co-payment is observed for very expensive drugs that cannot be fully paid for by the NHI.

A2b. Referral to See a Specialist

In the United States, most healthcare insurance companies will not allow patients to make appointments to see specialists. Although Medicare plans do not have restrictions on when to see a specialist, Medicare advantage plans might. For example, when one is enrolled in Medicare Part A and B, no special note is required to seek special care. Medicare Advantage is offered by private insurance companies and one is required to have a note from the primary care provider before they can see a specialist. Medicare supplement (Medigap) is available to share out-of-pocket costs but does not deal with referrals. Health Maintenance Organizations (HMO) plans are examples of private insurance plans that require individuals to receive referrals from their primary care doctors.

The Japanese healthcare system is similar to the US system where those in public insurance plans do not require special notes to see specialists. Patients in Japan are free to walk into the doctor’s office and seek medical care (Tikkanen et al., 2020). In special cases like a referral from one institution to the other, a referral note may be required. For special services like dental care, a referral note may be necessary because of cost issues and those who default may pay an extra fee of up to ¥ 11,000.

A2c. Coverage for Preexisting Conditions

Preexisting conditions during health insurance coverage represent any health problems that individuals had before starting an insurance plan. The United States law dictates that companies cannot refuse to cover preexisting conditions both for adults and children (Ruggles et al., 2019). Medicare and Medicaid plans including Medicare Advantage plans provide insurance coverage for preexisting conditions. For those with chronic conditions like end-stage renal disease, original medicare Part A and Part B is available. These plans are restricted to those aged 65 or older, 65 and below with disabilities, or any age with ESRD (United States Department of Labor, 2022). In Japan, NHI and social health insurance ensure all healthcare conditions are covered. There are no denials of coverage for preexisting conditions because costs for treatment and medication are set by the government.

A3. Financial Implications for Healthcare Delivery

The first implication of healthcare financing in the US and Japan is the out-of-pocket spending that comes with healthcare. Compared to patients from Japan, Americans are likely to spend more when seeking treatment with the current Medicare and Medicaid plans. For example, patients in the US must have certain plans to access essential drugs and services. Retirement before the age of 65 means individuals will have to seek alternative private insurance plans before eligibility for Medicare is met. In Japan, patients are only required to pay 30% of the total treatment fee with special populations like the elderly and children receiving free medical care. Secondly, individuals in the US spend more on special services and referrals compared to the Japanese. Patients have to confirm from the insurer if special services will be covered and sometimes they will use their own money to seek special care. Although the same may apply in some Japanese healthcare institutions, their patients are free to walk into any doctor’s office without a referral.


References

Children’s Hospital Association. (2021). Health care coverage sources for America’s children. https://www.childrenshospitals.org/issues-and-advocacy/general/fact-sheets/health-care-coverage-sources-for-americas-children

Japanese Healthcare Info. (n.d.). Japanese insurance for children. https://japanhealthinfo.com/child-health-and-childcare/japanese-insurance-for-children/#:~:text=Japanese%20Insurance%20pays%2070%25%20of,the%20rest%20of%20the%2030%25.

Shrank, W. H., DeParle, N. A., Gottlieb, S., Jain, S. H., Orszag, P., Powers, B. W., & Wilensky, G. R. (2021). Health costs and financing: Challenges and strategies for a new administration: Commentary recommends health cost, financing, and other priorities for a new US administration. Health Affairs, 40(2), 235-242. https://doi.org/10.1377/hlthaff.2020.01560

Tikkanen, R., Osborn, R., Mossialos, E., Djordjevic, A., & Wharton, G. (2020). International healthcare system profiles: Japan. The Commonwealth Fund. https://www.commonwealthfund.org/international-health-policy-center/countries/japan

United States Department of Labor. (2022). Employment & training administration: State unemployment insurance benefits.

https://oui.doleta.gov/unemploy/uifactsheet.asp

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