Healthcare access is the ease with which a person may obtain the required medical services. Many researchers examine the geographic, economic, cultural, and social factors that impact the access to healthcare globally (Givan, 2016). Healthcare access often varies among individuals, communities, and countries and it is mostly affected by various economic and social conditions as well as a region's health policies. Nations and jurisdictions have different plans and policies associated with their respective population healthcare objectives within society. Healthcare systems are institutions developed to meet the different health requirements of a targeted populace. The healthcare systems' exact configurations differ amid sub-national and national entities. In certain countries, healthcare planning is usually distributed amid various market participants, while in other nations, healthcare planning is centrally executed by the government and other coordinating entities (Givan, 2016). A healthcare system that functions effectively often demands a robust financing strategy, an adequately trained workforce, reliable data which subsequently impacts healthcare policies and decisions, and adequately maintained health logistics and facilities to ensure the delivery of quality technologies and medications.
Significantly, different health care reforms typify the U.S.A and Japan. The Affordable Care Act (ACA) is the most important healthcare regulation sanctioned in the U.S since the establishment of Medicaid and Medicare. The legislation enacted a comprehensive reform aimed to improve the quality, affordability, and accessibility of healthcare (Givan, 2016). The healthcare system of Japan provides universal health care access and has significantly contributed to exceptional Japanese’ health status. In the U.S.A, children’s access to health care has been provided under the CHIP (Children’s Health Insurance Program) (Vindrola, Johnson, & Pfister, 2018). The CHIP insurance program offers a significantly low health care coverage costs to children in families whose income is significantly high to enhance their eligibility for Medicaid but inadequate to purchase private health insurance. The CHIP insurance coverage covers pregnant women in certain stated in the U.S. Every state offers the CHIP insurance coverage which is closely related to the state’s Medicaid program. A report by Lisa Rapport in 2016 revealed that over the past decade, a growing number of children in the U.S.A have under a health insurance coverage (Vindrola, Johnson, & Pfister, 2018). She further reports that there is a significant decline in the number of uninsured children. She attributes this outcome to the growth in Medicaid and the CHIP. Additionally, the report revealed a significant improvement in the access and quality of care.
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The unemployed individuals in the U.S.A may be eligible for a health insurance plan through COBRA, a federal regulation. According to the regulation (COBRA), if an individual’s former employer has over twenty employees, he is obligated by law to provide a health insurance coverage to discontinued or terminated workers for approximately eighteen months (Vindrola, Johnson, & Pfister, 2018). The stipulation appertains to employees who involuntarily or voluntarily leave their respective jobs or who still work at the organization but lose their insurance due to factors such as the change in hours. One is usually given a sixty-day window period to enroll in COBRA after leaving one’s job. Under the federal legislation, the ACA, unemployed individuals may find affordable health care coverage at the governments Health Insurance Marketplace. Individuals who retire below the age of sixty-five, thereby, losing their job-based health insurance plan may qualify for the Special Enrollment Period at the Health Insurance marketplace; this means that they could enroll to an insurance plan even if it is not within the yearly Open Enrollment Period. The retirees may be eligible for the Medicaid program or private insurance plan typified by premium tax credits and low out-of-pocket expenses or costs.
In Japan, children are covered under the Social Health Insurance and the National Health Insurance plan. The government often accounts for approximately seventy-percent of the total medical expenses (Takayama & Narukawa, 2016). Children may also apply for the Free Medical Care Certificate provided by their respective cities or wards who may be liable for the thirty percent total cost of treatment. With the certificate, a child may receive medication and treatment for absolutely free. The certificate is effective until the child attains fifteen years. However, the age limit often varies amid states. Baby checkups and vaccinations are usually covered under an insurance plan, although one’s city or ward office may give one, coupons to cater for these medical costs. In Japan, the unemployed individuals are required by the legislation to apply for National Health Insurance. Retired individuals under the age of seventy-five are also covered under the National Health Insurance program (Ikegami, 2014). The prefectural offices are currently administering the NHI plan. Under the plan, enrollees contribute through premium payments. However, approximately half of the benefit expenses are covered by tax subsidies.
Health care expenses are among the most significant contemporary health policy issue in the U.S. The country expends substantial amounts of money on health care compared to other nations. Prescription drugs are perceived as a significant contributor to increased healthcare costs. Pharmaceuticals account for approximately ten percent of the total costs in health care. Due to the increased pharmaceutical expenses, private and public insurance companies have imposed firm restrictions on the accessibility of prescription drugs; these companies have excluded the accessibility of certain drugs from their insurance coverage plans. Part D of Medicare's insurance plan stipulates the plan's prescription drug coverage and is available to every Medicare enrollee (Givan, 2016). The stipulation provides coverage for the prescription drug costs. However, it does not cover all costs. Japan’s current health insurance program is typified by a balanced fee plan, whereby, the government ascertains and controls the price rates of all medical drugs and procedures. The Japanese health insurance plan often covers seventy-percent of total prescription drug expenses (Takayama & Narukawa, 2016). One is, therefore, required to pay thirty percent at the pharmacy. However, non-prescription drugs are not covered under its insurance plan.
A specialty referral refers to the interface amid the specialist and referring provider (Givan, 2016). In the U.S, the referral procedure often commences with the referral decision-making process; this involves the physician’s choice to refer a particular patient to a specialist. A PCP’s decision to refer an individual ought to be pertinent, and the suitable specialist has to be identified to aid in the evaluation and management of the patient's condition. Secondly, the PCP often coordinates care through tracking or monitoring the referral and ensuring that it has been executed. The patient should also secure an appointment with the specialist; this is commonly referred to as specialty access. The PCP then transfers relevant patient data to the specialist; this includes previous examinations such as imaging and laboratory tests. After the specialist's assessment along with specialist care (therapeutic and diagnostic interventions), patient data findings and follow-up recommendations are then transferred by the specialist to the patient and PCP. The last phase is the care integration phase. Here the specialist and PCP consent to a particular management plan and the specialist's role. Japan's referral-based system is similar to that of the U.S. The process begins with the PCP's decision regarding a patient's need for referral. The physician then inscribes a referral letter for the patient which states the diagnoses. An appointment with the specialist is then secured. Care integration is the final stage in the referral system (Ikegami, 2014).
A pre-existing condition relates to a medical condition which existed before one's enrollment to a new health insurance plan or applied for a health insurance policy (Ikegami, 2014). Before the year 2014, certain insurance policies could not cover expenses or costs due to preexisting conditions. However, under the current legislation, health insurance organizations cannot refuse to cover an individual's costs or charge one more due to their pre-existing conditions. Nonetheless, the pre-existing condition's coverage regulation applies to a "grandfathered" personal health insurance policy; this is an insurance policy secured before 23rd March 2010 which has not been subjected to specific changes aimed at increasing consumer costs or reducing benefits (Vindrola, Johnson, & Pfister, 2018). The Japanese health insurance program, on the other hand, covers all prescription drug, dental, and medical needs of a patient. Under the insurance program, a patient can’t be denied coverage due to a pre-existing health condition.
The Affordable Care Act has been associated with increased premium costs and high deductible health plans (Vindrola, Johnson, & Pfister, 2018). Over the recent years, monthly premiums rates have increased significantly, particularly amid the insurance plans sold on the ACA’s health insurance exchanges. Various studies relate the increased monthly premium costs to the growing number of ACA enrollees. The ACA has also significantly contributed to the increased deductible health plans and out-of-pocket costs among patients in the U.S. the two primary financial implications among patients in Japan include low medical expenses and the significant reductions in out-of-pocket costs. The low medical expenses among patients in Japan may be attributed to the government’s capacity to control costs (Ikegami, 2014). In Japan, the government has imposed a national fee schedule which stipulates the limits on expenditure increases. The government coverage also accounts for approximately seventy percent of a patient’s total medical costs. The significant reductions in the out-of-pocket costs may be ascribed to the extensive coverage provisions under the insurance program.
References
Givan, R. K. (2016). The challenge to change : Reforming health care on the front line in the United States and the United Kingdom . Ithaca, NY: ILR Press.
Ikegami, N. (2014). Universal health coverage for inclusive and sustainable development: Lessons from Japan . Washington: World Bank Publications.
In Vindrola-Padros, C., In Johnson, G. A., & In Pfister, A. E. (2018). Healthcare in motion: Immobilities in health service delivery and access . New York: Berghahn Books.
Takayama, A., & Narukawa, M. (2016). Pharmaceutical pricing and reimbursement in Japan. Therapeutic Innovation & Regulatory Science , 50(3), 361–367.
