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It is essential for all nurse practitioners to understand the health care system in their area of practice. The U.S health care system has evolved over the decades in an attempt to offer the most affordable health care to all. The nation’s interest in health care systems of other countries has been inspired by the growing concern about cost, access, and delivery of health care in the Unites States. Comparative analysis of the health care system of the country and other advanced nations is necessary for the deep understanding of all the health care specifics. Industrialized nations have chosen different approaches to offer the solution to common concerns in health care, namely access, cost, and quality service delivery. As such, it is useful to compare the health care system of such developed nations as the United States and Japan.
Health Care Access
Health care access means having the efficient use of health services to attain the best health outcomes. The access to health care can be measured in different ways, including the accessibility of the health care facility, the availability of health practitioners, and the affordability of health care. The major barrier to accessing health care system in the United States is health insurance. In the U.S health care system, federal state Children’s Health Insurance Program covers children. In some states, citizens are covered by Medicaid (The Commonwealth Fund, 2014). However, unemployed and retirees have to choose marketplace plans, which makes it inaccessible to those who cannot afford any health insurance plans.
On the other hand, in Japan, all citizens are covered and patients do not have to visit a particular health facility. Therefore, the health care system is easily accessible to children, retirees, and unemployed (The Commonwealth Fund, 2008). The healthcare system of Japan, unlike that of the United States, offers free choice of health care providers, hence an increasing rate of accessibility since patients can visit their nearest health facility. Both national and local governments provide health care in Japan. As mentioned earlier, the government is responsible for setting the fee through a governmental committee; thus, the system provides for equal access to all. It is different from the United States system where health practitioners are responsible for setting their fees. Inequality in health care access is still rife in the United States because many children, unemployed, and retirees from low-income families are unable to access health care facilities, as most health care centers are located in wealthy regions. Statistics shows that Japanese people access health care services four times more often than average Americans do (The Commonwealth Fund, 2008).
Coverage for Medications
It is also vital to note that the United States does not have universal medical coverage but a hybrid system. The system allows its residents to receive private voluntary health insurance, employer-based insurance, and direct coverage through government programs such as Medicare, Medicaid, and military care (DPEAFLCIO, 2014). In the United States, a health care plan for children includes the Health Insurance Program, which offers coverage mainly to children in low-income households and private insurance plan for children from wealthy families. The opening of marketplaces that offer relatively cheaper premiums to low-income families and the expansion of Medicaid have enabled increased coverage. On the other hand, Japan’s system offers universal medical coverage in a number of health insurances (The Commonwealth Fund, 2014). They include employment-based health insurance for employed individuals, national health insurance for unemployed and self-employed people and, finally, the non-employment-based health insurance for elderly and retirees. In Japan, the universal health coverage is compulsory for everybody; thus, children, unemployed, and retirees are covered by the national health insurance plan. The government regulates the universal public health system and is responsible for setting fees schedule and offering subsidies to local governments, health care providers, and insurers to implement its policies (The Commonwealth Fund, 2014).
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Normally, a primary care practitioner who refers a patient to a specialist for treatment or tests issues a referral. In the U.S health care system, specialists can work in both public and private hospitals, and one needs a written referral letter first before seeing a specialist; otherwise, the health insurance plan will not pay for the services. This procedure is also similar to Japan health care system. The requirements to obtain a referral state that it should be written and duly signed by the referring physician, follow the set regulation, and have a clear outline of a single course of treatment. In addition, the validity period of the referral should be clearly indicated and medical fee account should contain the necessary information for the benefit to be paid.
Coverage for Pre-Existing Conditions
A pre-existing condition is a medical condition that existed before an individual obtained an insurance policy. In the United States, before the enactment of the Affordable Care Act, private health insurance companies used to deny patients with pre-existing conditions cover for treatment. Currently, the U.S health insurance plan offers a preexisting condition insurance plan for those who have a preexisting condition. Based on the law, every state is expected to have a pre-existing condition insurance plan. The U.S government under the Affordable Care Act has created a provision that requires all marketplace plans to cover treatment for the pre-existing condition. The act forbids raising premium rates due to pre-existing conditions once a patient is covered. Similarly, Japan’s national health insurance cover includes pre-existing condition. By law, the Japan health care insurance provider cannot reject a patient based on any pre-existing medical condition.
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Financial Implications for the Patient
Patients’ financial implications differ in two countries mainly due to the nature of coverage and the use of either multi-payer or single-payer system of health care financing. First, in Japan, all citizens are covered; therefore, patients pay a cheaper premium than in the United States where people are required to choose their health insurance plan. Furthermore, insurers do not negotiate for a fee since a uniform fee is applied regardless of where the service is offered (DPEAFLCIO, 2014). It means that low-income patients can access high-quality health care at cheaper costs as opposed to the United States where patients will pay a premium according to the level of quality of the health care that they can afford.
Second, in Japan, patients do not choose health insurance plan; thus, wealthy patients save much as compared to their counterparts in the United States, who choose insurance plan according to their financial status. In addition, health care practitioners in Japan do not decide on the treatment fee since the government determines it. For this reason, patients enjoy relatively cheaper health care services (The Commonwealth Fund, 2014). However, it has a negative impact on the service delivery. As compared to the United States where private health care provider decides on the treatment fee, the quality of the service delivery is relatively lower in Japan. Studies show that a higher number of patients access surgical operation services in the United States as compared to Japan.
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Comparative studies on health care systems in the United States and Japan show that Japan has a better health care system than the United States. The position is also supported by the statistical data that shows higher life expectancy in Japan, a higher rate of accessibility of health care, and cheaper health care provided to citizens in Japan as compared to the United States. However, some experts have also noted that Japan health care system is not sustainable in the end. Finally, with a consensus that it is not easy to find a perfect health care system, different approaches will continue to be experimented and health care systems will continue to evolve.
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