The paper will compare and contrast the United States healthcare system to that of Germany pointing out issues associated with access and coverage for the vulnerable populations. Additionally, financial implications for the patients will also be noted and the country with the least consequences identified.
The German healthcare system is deemed as one of the best in the world, and it is considered to pave the way for modern healthcare delivery systems. The system was first introduced in 1883 by Otto von Bismarck and Germany became the first country in the world to adopt the health insurance system (Busse, Blumel, Knieps, & Barnighausen, 2017). The insurance system states that all people contribute a proportion of their income towards self-health benefits. The system integrates a communist approach in that the high-income people support the disadvantaged. This translates to the young subsidizing the elderly and the healthy supporting the sick ones. This leads to a self-sustaining healthcare system.
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Initially, the German health insurance was limited to middle-level workers accounting for 10% of the population. However, the state made it compulsory for all the citizens to get insurance, which increased the number of individuals covered by the program. The healthcare system is divided into three main sectors which include the outpatient, inpatient care and rehabilitation facilities (Institute for Quality and Efficiency in Health Care, 2018). Health care system is tightly governed by multiple bodies which include the ministry of health and other regulatory authorities. Additionally, four principles guide the overall system; they include compulsory insurance which requires all citizens to have insurance, funding through insurance premiums, the principle of solidarity which dictates all people have an equal right to medical care and finally, the principle of self-governance.
Most of the German health insurance is publicly financed, accounting for around 74% in 2014 (Blumel & Busse, 2018). Despite this, 8.8 million Germans are still covered by private health insurance since it offers a broader array of services as compared to the statutory policy. The health insurance in Germany covers all medical services, including prescription drugs other than those excluded by law such as lifestyle drugs.
On the other hand, Scott (2016) suggests that the American health care system provokes much mass opinion with a thick line separating the two views, all based on insurance coverage. Covered individuals consider it the best, while uninsured deem it the worst. Initially, the United States traditionally involved an individual buying their health insurance. Privileged individuals had access to better doctors and top-notch hospitals, thereby translating to better health care services as compared to those who could not afford (Yakabuski, 2017). However, jobs that covered health insurance remained the go-to option for the average citizen, accounting for up to 156 million citizens. The health situation in the United States changed in 2010 when the Affordable Care Act was passed, and it entailed a multisectoral approach to the health care issue.
Healthcare responsibilities were to be shared among the government, employers and the individual, which ensured a significant improvement in health care coverage (Commonwealth Fund, 2018). The state regulates private insurance. The American health insurance covers only ten essential services that include: hospitalization, ambulatory, emergency, mental health and substance abuse, maternity, and newborn care, prescription drugs, rehabilitative services, laboratory services, preventive and chronic disease management, and pediatric services. However, each state determines the extent of the services covered, hence creating room for service inconsistencies.
Comparing the two health care delivery systems regarding coverage and medication, the American health care system, more so the public sector; entails differentiated categories of packages. The most common package is the Medicare for the elderly aged 65 years and older. The government controls it. The package may also include younger people with disabilities and people diagnosed with permanent kidney failure requiring dialysis or a transplant (Medicare.gov, 2018). Medicare offers a range of services including prescription drug coverage, but certain drugs such as weight loss, erectile dysfunction, and hair growth are not covered (Scott, 2016; Medicare.gov, 2018). Medication coverage in the United States is mostly controlled by the private sector since most pharmaceutical companies are privately owned. Coverage is relatively adequate; however, pricing is a factor that restricts many people from accessing the actual drugs. Alpern, Song, and Stauffer (2016) suggest that monopoly hinders access to medications for low-income individuals. Companies manipulate the market value of drugs for their gain at the expense of the people.
Medicaid is another public sector package which provides health coverage to low- income adults, children, pregnant women, and the unemployed individuals (Medicaid.gov, 2018; Scott, 2016). Eligibility is a strong deciding factor for this sort of coverage, with requirements being dictated by the federal government and implemented by the respective states. The children’s health insurance program (CHIP) covers children who are not eligible for Medicaid but can include pregnant women in some states. CHIP and Medicaid work closely to ensure universal coverage in the country (Healthcare.gov, 2018).
The German healthcare system is also similar to the American system in that everyone is covered in one way or another; however, the strategies implemented are different. In Germany, spouses and children are insured by the able family member at no additional cost. Eligibility for this depends on the other partner or child earning little to no income at all. Additionally, unemployed and retired individuals are covered by government health insurance (Institute for Quality and Efficiency in Health Care, 2018). The program includes children by default until they reach a certain age where additional considerations have to be made. Medication coverage in Germany is standardized and controlled by the national government. Pharmacists and physicians have access to software that tracks medication utilization in the country. The report from this software ensures equitable distribution of the drugs, hence adequate medication coverage in the country. Coverage in Germany is better than the American system since it is backed up by access.
The Children health care system in German has the least waiting time for appointments in all of Europe, offering same-day access to doctors’ offices. All health care is free of charge for all children and adolescents until they complete their education, after which either statutory or private health insurance covers them. Coverage for these two options ranks at 85% and 15% respectively (Ehrich, Grote, Gerber-Grote, and Strassburg, 2016). Looking at the two health care systems, it is clear that both of them are on track to achieving universal health care coverage for their respective populations.
However, several notable factors such as legislative reforms and demographic changes alter both of these strategies and hinder 100% health care coverage (Vogenberg and Santili, 2018; Ehrich, Grote, Gerber-Grote, and Strassburg, 2016). Health care delivery systems in both of these countries are strictly controlled by the federal governments, and it incorporates an aspect of insurance for the population. Insurance programs have rigid requirements, more so, health insurance programs since health care is an expensive service. Both countries have tried their best to facilitate affordable insurance packages for all their citizens despite the differences in income status.
Specialist care forms a fundamental part of any health care system in the world. Specialists are relatively expensive when compared to the general practitioners, thus warranting strict measures for one to see a specialist. Insurance organizations are particular with the conditions that necessitate the need for specialist care; since they are out to make profits and this form of care limits their profit margins. In the American health care system, for one to see a specialist, a written request from the primary care doctor is required. The primary care doctor capable of making such a claim is limited to the individual’s care provider. Failure of this written request warrants failure of the insurance provider to pay for the received treatment, resulting in out of the pocket expenditures (Healthcare.gov, 2018). The referral request is, however, not as simple as walking into your doctor and requesting for it. It involves a cross-check with your insurance cover to see the specialist options that are covered. Once this is done, the patient is then required to personally make an appointment with the specialist and ensure that the medical records have been forwarded to the requested specialist.
In Germany, outpatient care is solely provided by self-employed doctors. Most of these doctors have a legislative accreditation, hence in a position to treat anyone with federal health insurance. Specialist care in Germany takes a different approach when contrasted to the American requirements. For instance, specialist care can be recommended by a general practitioner, as is the case for the American system. However, referrals from the general practitioner are not necessary, and patients may bypass the general doctor and head straight for the specialist (Institute for Quality and Efficiency in Health Care, 2018). This slight variation gives Germany the upper hand when it comes to satisfactory health care delivery as compared to the United States. Significant factors play a vital role in this variation. For instance, the German health care system has had more than 100 years to mature and become sustainable, whereas, the modern American health care system is only a few decades old.
A further similarity exists in how the two countries accommodate preexisting medical conditions. Pre-existing medical conditions entail health parameters that an individual has before the start date of a new health coverage period, such as diabetes and cancer. Both countries have formulated rules that prevent discrimination in healthcare delivery for persons with prior medical conditions. For instance, the American government has a law that forbids insurance companies to refute or overcharge a client solely based on their existing medical condition (U.S. Department of Health & Human Services, 2018). In Germany, the situation is no different since the government dictates that all individuals should possess health insurance. The government in Germany allows the insurance providers to only charge the maximum allowable tariff for any existing condition (Welcome Center Germany, 2018).
As initially stated, healthcare systems are expensive, and despite the efforts in place by these two countries, financial implications are still present for the patients seeking health care. Financial implications generally lie in insurance coverage and out of pocket expenses for services not covered by the insurance programs. The American health care system impacts patients significantly as far as insurance coverage is concerned. Orton (2016) in his study noted that the annual premium for health insurance increased from $4,897.10 in 2013 to $6,251.96 in 2014. This was due to the adoption of the new health care system in the country. The implication was worsened by the subsequent reduction in services covered by the federal insurance. As such, services such as consultation fees were revoked resulting in the individual having to cover those costs.
This strategy leads to the second financial implication in the American health care system, which is out of pocket an expense. Orton (2016) further notes that consultation services can rank as high as $98 per visit. Moreover, some prescribed drugs which are deemed as ‘non-essential’ are not catered for, and the patient will have to pay extra for them. The German financial implications are somewhat different as compared to the American. Insurance premiums rank at an estimate of €775 per month, with the individual paying €425 and the rest €350 covered by the employer (Welcome Center Germany, 2018). The premiums are relatively costly as compared to the American; however, German premiums cover a more comprehensive array as compared to the American, thereby reducing instances of out of pocket expenses.
Similarly, the German healthcare insurance cover does not entail certain prescription drugs, thereby necessitating the need for the patient to cater for them using personal finances. Some of the medicines treat chronic conditions such as weight loss and erectile dysfunction and can, therefore, have a significant implication on the overall quality of life of the patient. In both countries, universal health care coverage has come a long way, but there is still room for improvement. I consider the German health care system to be a bit superior as compared to the American system. All in all, healthcare systems have come a long way, and they still have some way left to achieve adequate health coverage.
References
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