Healthcare Financing
When comparing the U.S. healthcare system with that of Japan, there are many differences to be found. Beginning with the U.S. healthcare system, the central element is an arrangement that pays for health services through employer-purchased insurance. There are a great deal of private insurance companies in the nation, reaching over 1200 in number. For the uninsured, the government pays for healthcare through systems such as Medicaid and Medicare. These plans follow different eligibilities, benefits, and reimbursement policies. The U.S. healthcare system’s strengths include high-quality services for those who have good insurance as well as a large number of physicians throughout the country.
The U.S. is also in the lead in terms of clinical and technological research and advancements. Insurance for those who are unemployed include marketplace insurance plans, Medicaid, and CHIP. CHIP (Children’s Health Insurance Program) is another program that offers low-cost health coverage to children in families that do not qualify for Medicaid (The U.S. Health Care System, 2017). Those who are retired without health coverage can use the Marketplace as well to buy insurance but have to pay a fee. However, nearly 15 percent of the population does not have any health insurance and the cost of healthcare is fairly high. Additionally, many individuals are denied insurance because of pre-existing conditions or high premiums.
On the other hand, Japan’s healthcare system makes health services available to all citizens through employer-purchased insurance. As a result, Japan stands as one of the healthiest nations in the world while also having one of the lowest costs. Coverage is universal and various insurance plans are involved. These plans are financed by payroll deductions, taxes, and patient co-payments. The government places a limit on expenditure increases and providers are paid by a nationally unvarying method and rate. In terms of child healthcare, copayments for children are often subsidized by local governments and children under the age of 6 do not have any costsharing fees (The Japanese Health Care System, 2017). Furthermore, those who enroll in Citizens Health Insurance who have low incomes, are unemployed, or retired are eligible for reduced premium payments. Weaknesses of Japan’s healthcare system include high financial incentives and preventive health exclusion for coverage does not include preventive health.
When looking at coverage for medications, in the U.S. most health plans will help to pay the cost of certain medications. Different insurers cover different ranges of medications, thus individuals must contact his/her insurance in order to find out what this list includes. Japan’s healthcare system covers all prescription drug needs that may arise and a patient cannot be denied coverage based on a pre-existing health condition (The Japanese Health Care System, 2017). Currently in the U.S., insurers also cannot deny one coverage based on pre-existing conditions (Cooper, 2018). When considering referrals to see specialists in the U.S., one must have a written order from his or her primary care provider. If no referral is given first, the insurance plan may not pay for the services needed and fees vary between specialties (The U.S. Health Care System, 2017). In Japan, most specialist care is provided in hospital outpatient departments or clinics and patients are able to visit without a written referral. Fees also do not typically vary by specialty.
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With regard to the healthcare delivery differences between the U.S. and Japan, it is clear that the amount of money spent out of pocket in the United States for healthcare is much greater than that of Japan. Overall, healthcare in the U.S. is more expensive and is not universal. The cost of healthcare is growing and sadly is already the “highest per person in the industrialized world” Many hospitals even go so far as to charge smaller insurers more in order to make up the difference of uncompensated costs from uninsured persons. Additionally, while about 25% of health care expenditures are paid out-of-pocket in the U.S., around 12% of costs are paid out-of-pocket in Japan. Japan also has a ceiling that limits healthcare prices from increasing (Cooper, 2018).
Another financial implication examines the overall health of each country. Japan ranks higher than the U.S. in several pertinent categories, including life expectancy for both men and women, quality of health care system (determined by factors such as short waiting time, number of available hospital beds), fewer deaths of infants, and fewer deaths from disease such as HIV and respiratory disease. The U.S. also has a higher rate of obesity and related diseases (Country vs country, 2018). Cost of treatment for chronic diseases such as heart disease is also extremely elevated when comparing to that of Japan – nearly twice the price.
References
- Country vs country: Japan and United States compared: Health stats. (2018). Retrieved February 1, 2018, from http://www.nationmaster.com/country-info/compare/Japan/United-States/Health
- Cooper, E. (2018). Comparing Health Care Systems. Retrieved February 1, 2018, from https://www.context.org/iclib/ic39/cooptalr/
- The Japanese Health Care System. (2017). Retrieved February 1, 2018, from http://international.commonwealthfund.org/countries/japan/
- The U.S. Health Care System. (2017). Retrieved February 1, 2018, from http://international.commonwealthfund.org/countries/united_states/
