Japan Single Payer powerpoint

TOPIC

UNITED STATES

COMPARATOR COUNTRY(JAPAN)

History of Managed Care and Health Insurance

· Managed care in the united states started in the 19th century when a few physicians in many cities in the united states began giving prepaid medical care to members of the unions, fraternal order, and many other workers' associations. The associations that were participating in the medical care had each member pay a small amount of money to physicians. Then they gain access toa wide range of health care services which the physician can provide. In the 20th century, the workers in companies such as mining, railroad, and lumbering companies came up with their own medical services.

· They contracted with the medical groups that provided care for their workers. It became widespread during the great recession where the employers and employees adopted Medicare services. In the 1970s, the federal government and other private firms started encouraging to join healthcare groups that pay for medical assistance in advance. The growth of prepaid healthcare services was slowly growing despite encouragement (Douthit, Dwolatzky, & Biswas, 2015). Coming to the 1980s, many employers turned to prepaid services for their workers until the 1990s when it increased significantly. Today many of the Americans are covered by either the private and the government-sponsored managed care.

· The health insurance system started to develop after the Meiji restoration when the western medication was introduced (Sakamoto et al.,2019). Therefore, the healthcare insurance was not established until 1927, where the first health insurance for employees was created in 1961. almost every individual in japan got insured by universal health insurance (Sasaki, Izawa & Okada, 2015). There was a difference in payments where those enrolled in employee health insurance paid the average amount for the first physician and the dependents.

· In contrast, those who were enrolled in the health insurance sponsored by the government paid 50% of the required fee. These enabled them to receive the services that they required plus the medications. In the 1980s, due to the changes in healthcare levels, the insurance systems were harmonized so that they could control the cost of service and medicine. Since then, the health insurance system has been well established in Japan.

Health & Benefit Plans

· There are some basics that an individual can benefits from the insurance scheme though it varies from one state to another.

· They include benefits include

outpatient care services and treatments in inpatient care services.

· Care before and after the child has been born. expenses are about the prescription of drugs.

· Mental health care services, including psychotherapy and counseling of the mental health patients.

Laboratory tests

Pediatric services such as dental and visual health care services

Preventive care services include vaccination, screening, counseling, and management of chronic diseases (Dieleman et al.,2017).

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· In Japan, healthcare insurance is a mandatory practice where some of the insurances offer preventive services that also include:

· the inpatient hospital cares

· outpatient medical care, mental health is also catered.

· Insurance caters for the drug prescriptions by the physicians, home healthcare services and dental healthcare services

Supplemental Insurance Available or Needed?

Medical supplementation is useful. For instance, when a person has retired, you realize that finding the cash to add to insurance cash is very difficult. It then becomes a wise decision to have a Medicare supplement plan, which may fill some gaps and put you at a better place during a crisis. The medical supplements are essential because the regular insurance does not cover you for everything, while Medigap is slightly higher in terms of cost, but it gives full coverage. Medical supplements are also better if you are admitted to the hospital for more than 60day with the regular insurance scheme. One is supposed to start paying some fee; therefore, supplements are essential as they also can cover co-payments and deductibles.

In Japan, supplementary health insurance is not needed because the systems of insurance in japan cater very well to its clients' requirements. Still, for the foreigners, it is necessary (Sakamoto et al.,2019).

Provider Contracting and Credentialing

· The provider should determine the party with which it will contract.

· Collect relevant information about contracting

· Initiate the contract with the companies that are contracting

· obtain the credentials such as the 10-digit identification number called national provider identifier and the tax identity number. (Webber, et al.,2019).

· Complete the application and keep on looking at the status of registration.

· contract rates and terms are then reviewed.

· objectionable conditions, if any, should be negotiated.

· The signing of the contract

Finally, the contract should be renewed and updating of the fee.

· They start by defining the scope of care they are providing

· Identification of the beneficiaries is then made.

· Identification of the type of privileges that the provider will offer.

· Assessment of the qualifications of the provider.

· Request for the benefits that you as a provider you need to have.

· Obtain the current licenses

· Development of a system that stores information.

Provider Payment

The employer makes payments to the insurance firm in which when the employee has received services. The physician claims it from the insurance firm

Health insurance is mandatory in Japan, and those that do not provide the card do not receive medication

Utilization and Quality Management

The united states have the best facilities, but currently, there has been a high cost of seeking medication. The medical insurance not covering entirely the medical cost means poor utilization and low quality of services compared to many industrialized countries (Dieleman et al.,2017).

Japan has a high quality in terms of the facilities with the best medical insurances. They have utilization levels that make both the healthcare services and the insurance systems the best among the industrialized countries (Sakamoto et al.,2019).

Governance & Administration

Governance and administration in the health care in the federal government's duty, but the current government have placed in it a lot of politics that is affecting healthcare services.

The government has made the medication in japan free enabling the Japanese citizens to receive free medical services that have led to increased life expectance.

Overall Health Outcome

The general outcomes in the united states health are far lower than the other industrialized countries, regardless of it being a wealthy country. However, life expectance has increased at a small margin.

Japan among the industrialized countries has achieved a lot of progress in terms of the healthcare systems. The expectance rates have been very high with where many of the diseases have found the proper address. Cases such as heart attacks have been on control. Many people have been saved, including those involved in accidents. The health care services are highly affordable.