lOMoARcPSD|61746433
Japan's Health Care System Vs. the US: Comparative Essay
PHCS 7000 - Introduction to the Health Care System
University of Cincinnati
lOMoARcPSD|61746433
It is an obvious fact that healthcare systems in different countries
differ. For this comparative essay, I chose the country of Japan, with
the intention of comparing its healthcare system with ours, America.
Access
Japan has a universal, public statutory health insurance system (SHIS)
that provides coverage regulated by the government.
It is mandatory for all citizens of all ages and anyone who will be
living in Japan for more than 90 days to enroll in a SHIS plan. 98.3 %
of the population is enrolled in SHIS, and the remaining 1.7% of
Japanese citizens are low-income and are enrolled in a public social
assistance program. The SHIS plan a person enrolls in is based on age,
employment status, and/or residency. There is also private health
insurance, but it is only supplemental or complementary to public
health insurance. In the SHIS, the Japanese government sets the fee
schedule and enforces regulations. Costs are simple and clearly laid
out. Most citizens pay a 30% coinsurance for services. There is a
reduced coinsurance of 20% for children aged 6 and younger and
adults aged 70 to 74 with lower incomes and only 10% coinsurance
for those aged 75 and older with lower incomes. There are no
deductibles in SHIS, and copayments for children’s health care are
often subsidized by the government. This simplistic fee schedule
cannot be said of the United States, there is a vast array of fees and
charges depending on what health coverage an individual has.
The United States does not have a universal healthcare system. Health
care coverage in the United States is a mixture of public and private,
as well as for-profit and nonprofit insurers. Options include fee-for-
service (FFS), preferred provider organization (PPO), point of service
lOMoARcPSD|61746433
(POS), health maintenance organization (HMO), Medicare, Medicaid,
and coverage from the Veterans Health Administration. A majority of
US citizens have private insurance that is often provided through their
employer, or they may buy it on their own. 12.5% of US adults are
uninsured, and countless more are underinsured. Lack of health
insurance is perhaps the greatest barrier to accessing health care
services and has a tremendous negative effect on an individual’s
overall health status.
The only thing close to a universal healthcare system in the United
States is the Patient Protection and Affordable Care Act ( PPACA),
which was signed into law in 2010. Its goal was to expand health
insurance coverage to Americans that were uninsured while
controlling costs and improving the quality of healthcare. Since its
beginning, it has been under scrutiny, and many parts have been
amended, including removing the penalty fee for those that did not
have health insurance. With the implementation of the PPACA,
different plan options became available for people to obtain insurance,
but private insurance is the primary health coverage for two-thirds of
Americans (67%). Over half of all private insurance is through
employers. Most employer plans cover their employees and give
various options on the level of coverage and also the option to insure
their family. Rarely an employer pays the entire premium. Most of the
time the cost is shared between the employer and employee. Only
11% of private health insurance is purchased by individuals from for-
profit and nonprofit carriers.
In America, retirees/seniors qualify for Medicare. It is a complex fee-
for-service program consisting of parts, A-D. Part A provides hospital
lOMoARcPSD|61746433
insurance and Part B medical insurance. Members can choose to get
their coverage just through traditional Medicare, or they can choose to
enroll in Part C which is a private health maintenance organization
(HMO) called Medicare Advantage. Part D is also optional and is for
prescription drug coverage. Medicare is financed through a
combination of general federal taxes, a mandatory payroll tax that
pays for Part A, and individual premiums.
The unemployed may qualify for Medicaid if their income is low. It is
a jointly sponsored state and federal program that pays for medical
services for persons who are elderly, poor, blind, or disabled, and for
certain families with dependent children who meet specified income
guidelines. Medicaid is obtained through the state of residency. The
state then received federal matching for providing the health coverage.
Veterans can receive healthcare coverage from the Veterans Health
Administration. It is America’s largest integrated healthcare system
serving 9 million enrolled Veterans each year. Having other health
insurance coverage like Medicare, Medicaid, or private insurance
doesn’t affect getting VA healthcare benefits. Each veteran’s medical
benefits package is unique. Covered benefits depend on the 'priority
group' and the advice of the VA primary provider. Retiring veterans
may also be eligible for TRICARE. It is a Medicare-wraparound
coverage for those that have Medicare Part A and B.
There are two US government-run programs available to children
from low-income households. Depending on income level, they may
qualify for Medicaid or the Children’s Health Insurance Program
(CHIP). CHIP is a state-administered public program created in 1997
for children in low-income families that earn too much to qualify for
lOMoARcPSD|61746433
Medicaid but are unlikely to be able to afford private insurance. CHIP
is funded through matching grants from the federal government to the
states, and most states charge a low premium and have small copays,
if any. Because it is state-administered, exactly how it works varies by
state. For example, it is considered an extension of Medicaid in some
states, while in others it is a separate program. Currently, 9.6 million
children are covered by this program.
Coverage of Medications
In Japan, the coverage for medication for children, the unemployed,
and the retired remain under the same rules as the coinsurance
percentages. Clinics can dispense medication directly to the patients or
they can go to the pharmacy. According to the Commonwealth Fund,
the use of pharmacies has been growing. Price revisions for
medications are also revised every 2 years. Usually, prices are lowered
for new drugs that are selling more than expected, and for brand-name
drugs when their generic counterparts become available. Prices of
generic drugs have gradually decreased. Also, if a physician
prescribes more than 6 drugs regularly to a patient, he receives a
reduced fee as a way to improve clinical decision-making.
In the US, the coverage for medication for children, the unemployed,
the and retired depends on the coverage they have.
Retired individuals with Medicare have the option to purchase private
prescription drug coverage under Medicare Part D. Part D covers most
outpatient drugs, like those that you would get a prescription for and
pick up at the pharmacy. Medicare Part B only covers very limited
outpatient prescription drug benefits, like injections that need to be
given by a medical professional. For Medicare Part D, copays and
lOMoARcPSD|61746433
coinsurance vary by drug plan: $0–$5 for preferred generics, up to
50% for non-preferred drugs. For the unemployed that qualify for
Medicaid, outpatient prescription drugs are an optional benefit under
federal law, however, currently, all states provide drug coverage. For
children with private health insurance, the copay for prescriptions
depends on that specific insurance coverage. For low-income children,
the copay for medications is reduced if part of CHIP or possibly free if
on Medicaid. Vaccines are often free to uninsured and underinsured
children.
Referral to See a Specialist
In Japan, there is no 'gatekeeper'. Children, the unemployed, and the
retired do not need to get a referral to go see a specialist. The term
'general practice' in Japan is recent, but historically, there has been no
distinction between primary care and specialty care. The fee schedule
remains the same for all providers. Patients can see a specialist
without a referral and most of the time on a walk-in basis.
A 'gatekeeper' is very common for healthcare coverage in the United
States. American children, the unemployed, and the retired are often
limited to specialty services if it is not deemed necessary or they
cannot afford the excessive fees. PPO plans often can schedule an
appointment with a specialist without permission from their primary
care provider, but those with an HMO or government-sponsored plan
do not have that option. Outpatient specialists are free to choose which
form of insurance they will accept, or whether they will accept it at
all. For example, not all specialists accept publicly insured patients,
because of the relatively lower reimbursement rates set by Medicaid
and Medicare. Access to specialists for beneficiaries of these
lOMoARcPSD|61746433
programs—not to mention for people without any insurance—can
therefore be particularly limited.
Coverage for Preexisting Conditions
In Japan, no one can be excluded from any coverage based on a
preexisting condition. This also became true in the United States.
Under current law, health insurance companies can’t refuse to cover
you or charge you more just because you have a 'pre-existing
condition', that is, a health problem you had before the date that new
health coverage starts.
Finance Implications for Healthcare Delivery
In Japan, people benefit from the universal healthcare delivery system.
All fees are determined by the government and therefore controlled.
Even though most hospitals and medical offices are privately run, they
are limited on what they can charge based on government regulations.
This allows individuals to seek medical treatment and preventative
services more often, thus leading to better health. Not only is health
benefited but a person benefits financially as well. Unlike Americans,
the Japanese do not need to worry that paying for healthcare will lead
to financial ruin. A hospital stay is in the hundreds, whereas in the
United States, it is in the thousand and can leave a person bankrupt.
Americans often go without medical treatment simply based on the
fact that they cannot afford it. Especially if they do not have health
insurance, like in the circumstance of losing a job. In Japan, if a
person loses their job their health coverage just switches from the
employer to a community plan.
The negative financial implications of Japan’s healthcare structure fall
on the providers. 50% of hospitals are in financial deficit. This is the
lOMoARcPSD|61746433
opposite in America, where hospitals and doctors make a profit at the
expense of the people. In America private practices can, and often do,
refuse services to those with government-sponsored insurance like
Medicaid. This is mostly due to the low reimbursement and the length
of time to receive payment. This is not allowed in Japan. There are
also disincentives for providers prescribing certain medications or
services because the price is then lowered upon the next government
review of fees. Again, this benefits the consumer, not the provider.
In America, both public and private insurers determine their benefit
packages and cost-sharing structures as long as it is within federal and
state regulations. Private insurers in America are for-profit, while
Japan’s statutory health insurance system (SHIS) is a not-for-profit
system. Insurers in Japan are not out to make a profit. Anything
money not used is carried over to the next year, which could lead to
premiums being reduced.
Conclusion
In summary, the comparative analysis covered in this essay has shown
that the healthcare systems of Japan and America, although they share
some common features, are nevertheless different. As for me, I would
prefer the Japanese system, for its accessibility, simplicity, and
orientation for the benefit of its population.
The United States does not have a universal healthcare system. Health
care coverage in the United States is a mixture of public and private,
as well as for-profit and nonprofit insurers. Options include fee-for-
service (FFS), preferred provider organization (PPO), point of service
(POS), health maintenance organization (HMO), Medicare, Medicaid,
and coverage from the Veterans Health Administration. A majority of
lOMoARcPSD|61746433
US citizens have private insurance that is often provided through their
employer, or they may buy it on their own. 12.5% of US adults are
uninsured, and countless more are underinsured. Lack of health
insurance is perhaps the greatest barrier to accessing health care
services and has a tremendous negative effect on an individual’s
overall health status.
The only thing close to a universal healthcare system in the United
States is the Patient Protection and Affordable Care Act ( PPACA),
which was signed into law in 2010. Its goal was to expand health
insurance coverage to Americans that were uninsured while
controlling costs and improving the quality of healthcare. Since its
beginning, it has been under scrutiny, and many parts have been
amended, including removing the penalty fee for those that did not
have health insurance. With the implementation of the PPACA,
different plan options became available for people to obtain insurance,
but private insurance is the primary health coverage for two-thirds of
Americans (67%). Over half of all private insurance is through
employers. Most employer plans cover their employees and give
various options on the level of coverage and also the option to insure
their family. Rarely an employer pays the entire premium. Most of the
time the cost is shared between the employer and employee. Only
11% of private health insurance is purchased by individuals from for-
profit and nonprofit carriers.
In America, retirees/seniors qualify for Medicare. It is a complex fee-
for-service program consisting of parts, A-D. Part A provides hospital
insurance and Part B medical insurance. Members can choose to get
their coverage just through traditional Medicare, or they can choose to
lOMoARcPSD|61746433
enroll in Part C which is a private health maintenance organization
(HMO) called Medicare Advantage. Part D is also optional and is for
prescription drug coverage. Medicare is financed through a
combination of general federal taxes, a mandatory payroll tax that
pays for Part A, and individual premiums.
The unemployed may qualify for Medicaid if their income is low. It is
a jointly sponsored state and federal program that pays for medical
services for persons who are elderly, poor, blind, or disabled, and for
certain families with dependent children who meet specified income
guidelines. Medicaid is obtained through the state of residency. The
state then received federal matching for providing the health coverage.
Veterans can receive healthcare coverage from the Veterans Health
Administration. It is America’s largest integrated healthcare system
serving 9 million enrolled Veterans each year. Having other health
insurance coverage like Medicare, Medicaid, or private insurance
doesn’t affect getting VA healthcare benefits. Each veteran’s medical
benefits package is unique. Covered benefits depend on the 'priority
group' and the advice of the VA primary provider. Retiring veterans
may also be eligible for TRICARE. It is a Medicare-wraparound
coverage for those that have Medicare Part A and B.
There are two US government-run programs available to children
from low-income households. Depending on income level, they may
qualify for Medicaid or the Children’s Health Insurance Program
(CHIP). CHIP is a state-administered public program created in 1997
for children in low-income families that earn too much to qualify for
Medicaid but are unlikely to be able to afford private insurance. CHIP
is funded through matching grants from the federal government to the
lOMoARcPSD|61746433
states, and most states charge a low premium and have small copays,
if any. Because it is state-administered, exactly how it works varies by
state. For example, it is considered an extension of Medicaid in some
states, while in others it is a separate program. Currently, 9.6 million
children are covered by this program.
Coverage of Medications
In Japan, the coverage for medication for children, the unemployed,
and the retired remain under the same rules as the coinsurance
percentages. Clinics can dispense medication directly to the patients or
they can go to the pharmacy. According to the Commonwealth Fund,
the use of pharmacies has been growing. Price revisions for
medications are also revised every 2 years. Usually, prices are lowered
for new drugs that are selling more than expected, and for brand-name
drugs when their generic counterparts become available. Prices of
generic drugs have gradually decreased. Also, if a physician
prescribes more than 6 drugs regularly to a patient, he receives a
reduced fee as a way to improve clinical decision-making.
In the US, the coverage for medication for children, the unemployed,
the and retired depends on the coverage they have.
Retired individuals with Medicare have the option to purchase private
prescription drug coverage under Medicare Part D. Part D covers most
outpatient drugs, like those that you would get a prescription for and
pick up at the pharmacy. Medicare Part B only covers very limited
outpatient prescription drug benefits, like injections that need to be
given by a medical professional. For Medicare Part D, copays and
coinsurance vary by drug plan: $0–$5 for preferred generics, up to
50% for non-preferred drugs. For the unemployed that qualify for
lOMoARcPSD|61746433
Medicaid, outpatient prescription drugs are an optional benefit under
federal law, however, currently, all states provide drug coverage. For
children with private health insurance, the copay for prescriptions
depends on that specific insurance coverage. For low-income children,
the copay for medications is reduced if part of CHIP or possibly free if
on Medicaid. Vaccines are often free to uninsured and underinsured
children.
Referral to See a Specialist
In Japan, there is no 'gatekeeper'. Children, the unemployed, and the
retired do not need to get a referral to go see a specialist. The term
'general practice' in Japan is recent, but historically, there has been no
distinction between primary care and specialty care. The fee schedule
remains the same for all providers. Patients can see a specialist
without a referral and most of the time on a walk-in basis.
A 'gatekeeper' is very common for healthcare coverage in the United
States. American children, the unemployed, and the retired are often
limited to specialty services if it is not deemed necessary or they
cannot afford the excessive fees. PPO plans often can schedule an
appointment with a specialist without permission from their primary
care provider, but those with an HMO or government-sponsored plan
do not have that option. Outpatient specialists are free to choose which
form of insurance they will accept, or whether they will accept it at
all. For example, not all specialists accept publicly insured patients,
because of the relatively lower reimbursement rates set by Medicaid
and Medicare. Access to specialists for beneficiaries of these
programs—not to mention for people without any insurance—can
therefore be particularly limited.
lOMoARcPSD|61746433
Coverage for Preexisting Conditions
In Japan, no one can be excluded from any coverage based on a
preexisting condition. This also became true in the United States.
Under current law, health insurance companies can’t refuse to cover
you or charge you more just because you have a 'pre-existing
condition', that is, a health problem you had before the date that new
health coverage starts.
Finance Implications for Healthcare Delivery
In Japan, people benefit from the universal healthcare delivery system.
All fees are determined by the government and therefore controlled.
Even though most hospitals and medical offices are privately run, they
are limited on what they can charge based on government regulations.
This allows individuals to seek medical treatment and preventative
services more often, thus leading to better health. Not only is health
benefited but a person benefits financially as well. Unlike Americans,
the Japanese do not need to worry that paying for healthcare will lead
to financial ruin. A hospital stay is in the hundreds, whereas in the
United States, it is in the thousand and can leave a person bankrupt.
Americans often go without medical treatment simply based on the
fact that they cannot afford it. Especially if they do not have health
insurance, like in the circumstance of losing a job. In Japan, if a
person loses their job their health coverage just switches from the
employer to a community plan.
The negative financial implications of Japan’s healthcare structure fall
on the providers. 50% of hospitals are in financial deficit. This is the
opposite in America, where hospitals and doctors make a profit at the
expense of the people. In America private practices can, and often do,
lOMoARcPSD|61746433
refuse services to those with government-sponsored insurance like
Medicaid. This is mostly due to the low reimbursement and the length
of time to receive payment. This is not allowed in Japan. There are
also disincentives for providers prescribing certain medications or
services because the price is then lowered upon the next government
review of fees. Again, this benefits the consumer, not the provider.
In America, both public and private insurers determine their benefit
packages and cost-sharing structures as long as it is within federal and
state regulations. Private insurers in America are for-profit, while
Japan’s statutory health insurance system (SHIS) is a not-for-profit
system. Insurers in Japan are not out to make a profit. Anything
money not used is carried over to the next year, which could lead to
premiums being reduced.
Conclusion
In summary, the comparative analysis covered in this essay has shown
that the healthcare systems of Japan and America, although they share
some common features, are nevertheless different. As for me, I would
prefer the Japanese system, for its accessibility, simplicity, and
orientation for the benefit of its population.
The United States does not have a universal healthcare system. Health
care coverage in the United States is a mixture of public and private,
as well as for-profit and nonprofit insurers. Options include fee-for-
service (FFS), preferred provider organization (PPO), point of service
(POS), health maintenance organization (HMO), Medicare, Medicaid,
and coverage from the Veterans Health Administration. A majority of
US citizens have private insurance that is often provided through their
employer, or they may buy it on their own. 12.5% of US adults are
lOMoARcPSD|61746433
uninsured, and countless more are underinsured. Lack of health
insurance is perhaps the greatest barrier to accessing health care
services and has a tremendous negative effect on an individual’s
overall health status.
The only thing close to a universal healthcare system in the United
States is the Patient Protection and Affordable Care Act ( PPACA),
which was signed into law in 2010. Its goal was to expand health
insurance coverage to Americans that were uninsured while
controlling costs and improving the quality of healthcare. Since its
beginning, it has been under scrutiny, and many parts have been
amended, including removing the penalty fee for those that did not
have health insurance. With the implementation of the PPACA,
different plan options became available for people to obtain insurance,
but private insurance is the primary health coverage for two-thirds of
Americans (67%). Over half of all private insurance is through
employers. Most employer plans cover their employees and give
various options on the level of coverage and also the option to insure
their family. Rarely an employer pays the entire premium. Most of the
time the cost is shared between the employer and employee. Only
11% of private health insurance is purchased by individuals from for-
profit and nonprofit carriers.
In America, retirees/seniors qualify for Medicare. It is a complex fee-
for-service program consisting of parts, A-D. Part A provides hospital
insurance and Part B medical insurance. Members can choose to get
their coverage just through traditional Medicare, or they can choose to
enroll in Part C which is a private health maintenance organization
(HMO) called Medicare Advantage. Part D is also optional and is for
lOMoARcPSD|61746433
prescription drug coverage. Medicare is financed through a
combination of general federal taxes, a mandatory payroll tax that
pays for Part A, and individual premiums.
The unemployed may qualify for Medicaid if their income is low. It is
a jointly sponsored state and federal program that pays for medical
services for persons who are elderly, poor, blind, or disabled, and for
certain families with dependent children who meet specified income
guidelines. Medicaid is obtained through the state of residency. The
state then received federal matching for providing the health coverage.
Veterans can receive healthcare coverage from the Veterans Health
Administration. It is America’s largest integrated healthcare system
serving 9 million enrolled Veterans each year. Having other health
insurance coverage like Medicare, Medicaid, or private insurance
doesn’t affect getting VA healthcare benefits. Each veteran’s medical
benefits package is unique. Covered benefits depend on the 'priority
group' and the advice of the VA primary provider. Retiring veterans
may also be eligible for TRICARE. It is a Medicare-wraparound
coverage for those that have Medicare Part A and B.
There are two US government-run programs available to children
from low-income households. Depending on income level, they may
qualify for Medicaid or the Children’s Health Insurance Program
(CHIP). CHIP is a state-administered public program created in 1997
for children in low-income families that earn too much to qualify for
Medicaid but are unlikely to be able to afford private insurance. CHIP
is funded through matching grants from the federal government to the
states, and most states charge a low premium and have small copays,
if any. Because it is state-administered, exactly how it works varies by
lOMoARcPSD|61746433
state. For example, it is considered an extension of Medicaid in some
states, while in others it is a separate program. Currently, 9.6 million
children are covered by this program.
Coverage of Medications
In Japan, the coverage for medication for children, the unemployed,
and the retired remain under the same rules as the coinsurance
percentages. Clinics can dispense medication directly to the patients or
they can go to the pharmacy. According to the Commonwealth Fund,
the use of pharmacies has been growing. Price revisions for
medications are also revised every 2 years. Usually, prices are lowered
for new drugs that are selling more than expected, and for brand-name
drugs when their generic counterparts become available. Prices of
generic drugs have gradually decreased. Also, if a physician
prescribes more than 6 drugs regularly to a patient, he receives a
reduced fee as a way to improve clinical decision-making.
In the US, the coverage for medication for children, the unemployed,
the and retired depends on the coverage they have.
Retired individuals with Medicare have the option to purchase private
prescription drug coverage under Medicare Part D. Part D covers most
outpatient drugs, like those that you would get a prescription for and
pick up at the pharmacy. Medicare Part B only covers very limited
outpatient prescription drug benefits, like injections that need to be
given by a medical professional. For Medicare Part D, copays and
coinsurance vary by drug plan: $0–$5 for preferred generics, up to
50% for non-preferred drugs. For the unemployed that qualify for
Medicaid, outpatient prescription drugs are an optional benefit under
federal law, however, currently, all states provide drug coverage. For
lOMoARcPSD|61746433
children with private health insurance, the copay for prescriptions
depends on that specific insurance coverage. For low-income children,
the copay for medications is reduced if part of CHIP or possibly free if
on Medicaid. Vaccines are often free to uninsured and underinsured
children.
Referral to See a Specialist
In Japan, there is no 'gatekeeper'. Children, the unemployed, and the
retired do not need to get a referral to go see a specialist. The term
'general practice' in Japan is recent, but historically, there has been no
distinction between primary care and specialty care. The fee schedule
remains the same for all providers. Patients can see a specialist
without a referral and most of the time on a walk-in basis.
A 'gatekeeper' is very common for healthcare coverage in the United
States. American children, the unemployed, and the retired are often
limited to specialty services if it is not deemed necessary or they
cannot afford the excessive fees. PPO plans often can schedule an
appointment with a specialist without permission from their primary
care provider, but those with an HMO or government-sponsored plan
do not have that option. Outpatient specialists are free to choose which
form of insurance they will accept, or whether they will accept it at
all. For example, not all specialists accept publicly insured patients,
because of the relatively lower reimbursement rates set by Medicaid
and Medicare. Access to specialists for beneficiaries of these
programs—not to mention for people without any insurance—can
therefore be particularly limited.
Coverage for Preexisting Conditions
lOMoARcPSD|61746433
In Japan, no one can be excluded from any coverage based on a
preexisting condition. This also became true in the United States.
Under current law, health insurance companies can’t refuse to cover
you or charge you more just because you have a 'pre-existing
condition', that is, a health problem you had before the date that new
health coverage starts.
Finance Implications for Healthcare Delivery
In Japan, people benefit from the universal healthcare delivery system.
All fees are determined by the government and therefore controlled.
Even though most hospitals and medical offices are privately run, they
are limited on what they can charge based on government regulations.
This allows individuals to seek medical treatment and preventative
services more often, thus leading to better health. Not only is health
benefited but a person benefits financially as well. Unlike Americans,
the Japanese do not need to worry that paying for healthcare will lead
to financial ruin. A hospital stay is in the hundreds, whereas in the
United States, it is in the thousand and can leave a person bankrupt.
Americans often go without medical treatment simply based on the
fact that they cannot afford it. Especially if they do not have health
insurance, like in the circumstance of losing a job. In Japan, if a
person loses their job their health coverage just switches from the
employer to a community plan.
The negative financial implications of Japan’s healthcare structure fall
on the providers. 50% of hospitals are in financial deficit. This is the
opposite in America, where hospitals and doctors make a profit at the
expense of the people. In America private practices can, and often do,
refuse services to those with government-sponsored insurance like
lOMoARcPSD|61746433
Medicaid. This is mostly due to the low reimbursement and the length
of time to receive payment. This is not allowed in Japan. There are
also disincentives for providers prescribing certain medications or
services because the price is then lowered upon the next government
review of fees. Again, this benefits the consumer, not the provider.
In America, both public and private insurers determine their benefit
packages and cost-sharing structures as long as it is within federal and
state regulations. Private insurers in America are for-profit, while
Japan’s statutory health insurance system (SHIS) is a not-for-profit
system. Insurers in Japan are not out to make a profit. Anything
money not used is carried over to the next year, which could lead to
premiums being reduced.
Conclusion
In summary, the comparative analysis covered in this essay has shown
that the healthcare systems of Japan and America, although they share
some common features, are nevertheless different. As for me, I would
prefer the Japanese system, for its accessibility, simplicity, and
orientation for the benefit of its population.
The United States does not have a universal healthcare system. Health
care coverage in the United States is a mixture of public and private,
as well as for-profit and nonprofit insurers. Options include fee-for-
service (FFS), preferred provider organization (PPO), point of service
(POS), health maintenance organization (HMO), Medicare, Medicaid,
and coverage from the Veterans Health Administration. A majority of
US citizens have private insurance that is often provided through their
employer, or they may buy it on their own. 12.5% of US adults are
uninsured, and countless more are underinsured. Lack of health
lOMoARcPSD|61746433
insurance is perhaps the greatest barrier to accessing health care
services and has a tremendous negative effect on an individual’s
overall health status.
The only thing close to a universal healthcare system in the United
States is the Patient Protection and Affordable Care Act ( PPACA),
which was signed into law in 2010. Its goal was to expand health
insurance coverage to Americans that were uninsured while
controlling costs and improving the quality of healthcare. Since its
beginning, it has been under scrutiny, and many parts have been
amended, including removing the penalty fee for those that did not
have health insurance. With the implementation of the PPACA,
different plan options became available for people to obtain insurance,
but private insurance is the primary health coverage for two-thirds of
Americans (67%). Over half of all private insurance is through
employers. Most employer plans cover their employees and give
various options on the level of coverage and also the option to insure
their family. Rarely an employer pays the entire premium. Most of the
time the cost is shared between the employer and employee. Only
11% of private health insurance is purchased by individuals from for-
profit and nonprofit carriers.
In America, retirees/seniors qualify for Medicare. It is a complex fee-
for-service program consisting of parts, A-D. Part A provides hospital
insurance and Part B medical insurance. Members can choose to get
their coverage just through traditional Medicare, or they can choose to
enroll in Part C which is a private health maintenance organization
(HMO) called Medicare Advantage. Part D is also optional and is for
prescription drug coverage. Medicare is financed through a
lOMoARcPSD|61746433
combination of general federal taxes, a mandatory payroll tax that
pays for Part A, and individual premiums.
The unemployed may qualify for Medicaid if their income is low. It is
a jointly sponsored state and federal program that pays for medical
services for persons who are elderly, poor, blind, or disabled, and for
certain families with dependent children who meet specified income
guidelines. Medicaid is obtained through the state of residency. The
state then received federal matching for providing the health coverage.
Veterans can receive healthcare coverage from the Veterans Health
Administration. It is America’s largest integrated healthcare system
serving 9 million enrolled Veterans each year. Having other health
insurance coverage like Medicare, Medicaid, or private insurance
doesn’t affect getting VA healthcare benefits. Each veteran’s medical
benefits package is unique. Covered benefits depend on the 'priority
group' and the advice of the VA primary provider. Retiring veterans
may also be eligible for TRICARE. It is a Medicare-wraparound
coverage for those that have Medicare Part A and B.
There are two US government-run programs available to children
from low-income households. Depending on income level, they may
qualify for Medicaid or the Children’s Health Insurance Program
(CHIP). CHIP is a state-administered public program created in 1997
for children in low-income families that earn too much to qualify for
Medicaid but are unlikely to be able to afford private insurance. CHIP
is funded through matching grants from the federal government to the
states, and most states charge a low premium and have small copays,
if any. Because it is state-administered, exactly how it works varies by
state. For example, it is considered an extension of Medicaid in some
lOMoARcPSD|61746433
states, while in others it is a separate program. Currently, 9.6 million
children are covered by this program.
Coverage of Medications
In Japan, the coverage for medication for children, the unemployed,
and the retired remain under the same rules as the coinsurance
percentages. Clinics can dispense medication directly to the patients or
they can go to the pharmacy. According to the Commonwealth Fund,
the use of pharmacies has been growing. Price revisions for
medications are also revised every 2 years. Usually, prices are lowered
for new drugs that are selling more than expected, and for brand-name
drugs when their generic counterparts become available. Prices of
generic drugs have gradually decreased. Also, if a physician
prescribes more than 6 drugs regularly to a patient, he receives a
reduced fee as a way to improve clinical decision-making.
In the US, the coverage for medication for children, the unemployed,
the and retired depends on the coverage they have.
Retired individuals with Medicare have the option to purchase private
prescription drug coverage under Medicare Part D. Part D covers most
outpatient drugs, like those that you would get a prescription for and
pick up at the pharmacy. Medicare Part B only covers very limited
outpatient prescription drug benefits, like injections that need to be
given by a medical professional. For Medicare Part D, copays and
coinsurance vary by drug plan: $0–$5 for preferred generics, up to
50% for non-preferred drugs. For the unemployed that qualify for
Medicaid, outpatient prescription drugs are an optional benefit under
federal law, however, currently, all states provide drug coverage. For
children with private health insurance, the copay for prescriptions
lOMoARcPSD|61746433
depends on that specific insurance coverage. For low-income children,
the copay for medications is reduced if part of CHIP or possibly free if
on Medicaid. Vaccines are often free to uninsured and underinsured
children.
Referral to See a Specialist
In Japan, there is no 'gatekeeper'. Children, the unemployed, and the
retired do not need to get a referral to go see a specialist. The term
'general practice' in Japan is recent, but historically, there has been no
distinction between primary care and specialty care. The fee schedule
remains the same for all providers. Patients can see a specialist
without a referral and most of the time on a walk-in basis.
A 'gatekeeper' is very common for healthcare coverage in the United
States. American children, the unemployed, and the retired are often
limited to specialty services if it is not deemed necessary or they
cannot afford the excessive fees. PPO plans often can schedule an
appointment with a specialist without permission from their primary
care provider, but those with an HMO or government-sponsored plan
do not have that option. Outpatient specialists are free to choose which
form of insurance they will accept, or whether they will accept it at
all. For example, not all specialists accept publicly insured patients,
because of the relatively lower reimbursement rates set by Medicaid
and Medicare. Access to specialists for beneficiaries of these
programs—not to mention for people without any insurance—can
therefore be particularly limited.
Coverage for Preexisting Conditions
In Japan, no one can be excluded from any coverage based on a
preexisting condition. This also became true in the United States.
lOMoARcPSD|61746433
Under current law, health insurance companies can’t refuse to cover
you or charge you more just because you have a 'pre-existing
condition', that is, a health problem you had before the date that new
health coverage starts.
Finance Implications for Healthcare Delivery
In Japan, people benefit from the universal healthcare delivery system.
All fees are determined by the government and therefore controlled.
Even though most hospitals and medical offices are privately run, they
are limited on what they can charge based on government regulations.
This allows individuals to seek medical treatment and preventative
services more often, thus leading to better health. Not only is health
benefited but a person benefits financially as well. Unlike Americans,
the Japanese do not need to worry that paying for healthcare will lead
to financial ruin. A hospital stay is in the hundreds, whereas in the
United States, it is in the thousand and can leave a person bankrupt.
Americans often go without medical treatment simply based on the
fact that they cannot afford it. Especially if they do not have health
insurance, like in the circumstance of losing a job. In Japan, if a
person loses their job their health coverage just switches from the
employer to a community plan.
The negative financial implications of Japan’s healthcare structure fall
on the providers. 50% of hospitals are in financial deficit. This is the
opposite in America, where hospitals and doctors make a profit at the
expense of the people. In America private practices can, and often do,
refuse services to those with government-sponsored insurance like
Medicaid. This is mostly due to the low reimbursement and the length
of time to receive payment. This is not allowed in Japan. There are
lOMoARcPSD|61746433
also disincentives for providers prescribing certain medications or
services because the price is then lowered upon the next government
review of fees. Again, this benefits the consumer, not the provider.
In America, both public and private insurers determine their benefit
packages and cost-sharing structures as long as it is within federal and
state regulations. Private insurers in America are for-profit, while
Japan’s statutory health insurance system (SHIS) is a not-for-profit
system. Insurers in Japan are not out to make a profit. Anything
money not used is carried over to the next year, which could lead to
premiums being reduced.
Conclusion
In summary, the comparative analysis covered in this essay has shown
that the healthcare systems of Japan and America, although they share
some common features, are nevertheless different. As for me, I would
prefer the Japanese system, for its accessibility, simplicity, and
orientation for the benefit of its population.
The United States does not have a universal healthcare system. Health
care coverage in the United States is a mixture of public and private,
as well as for-profit and nonprofit insurers. Options include fee-for-
service (FFS), preferred provider organization (PPO), point of service
(POS), health maintenance organization (HMO), Medicare, Medicaid,
and coverage from the Veterans Health Administration. A majority of
US citizens have private insurance that is often provided through their
employer, or they may buy it on their own. 12.5% of US adults are
uninsured, and countless more are underinsured. Lack of health
insurance is perhaps the greatest barrier to accessing health care
lOMoARcPSD|61746433
services and has a tremendous negative effect on an individual’s
overall health status.
The only thing close to a universal healthcare system in the United
States is the Patient Protection and Affordable Care Act ( PPACA),
which was signed into law in 2010. Its goal was to expand health
insurance coverage to Americans that were uninsured while
controlling costs and improving the quality of healthcare. Since its
beginning, it has been under scrutiny, and many parts have been
amended, including removing the penalty fee for those that did not
have health insurance. With the implementation of the PPACA,
different plan options became available for people to obtain insurance,
but private insurance is the primary health coverage for two-thirds of
Americans (67%). Over half of all private insurance is through
employers. Most employer plans cover their employees and give
various options on the level of coverage and also the option to insure
their family. Rarely an employer pays the entire premium. Most of the
time the cost is shared between the employer and employee. Only
11% of private health insurance is purchased by individuals from for-
profit and nonprofit carriers.
In America, retirees/seniors qualify for Medicare. It is a complex fee-
for-service program consisting of parts, A-D. Part A provides hospital
insurance and Part B medical insurance. Members can choose to get
their coverage just through traditional Medicare, or they can choose to
enroll in Part C which is a private health maintenance organization
(HMO) called Medicare Advantage. Part D is also optional and is for
prescription drug coverage. Medicare is financed through a
lOMoARcPSD|61746433
combination of general federal taxes, a mandatory payroll tax that
pays for Part A, and individual premiums.
The unemployed may qualify for Medicaid if their income is low. It is
a jointly sponsored state and federal program that pays for medical
services for persons who are elderly, poor, blind, or disabled, and for
certain families with dependent children who meet specified income
guidelines. Medicaid is obtained through the state of residency. The
state then received federal matching for providing the health coverage.
Veterans can receive healthcare coverage from the Veterans Health
Administration. It is America’s largest integrated healthcare system
serving 9 million enrolled Veterans each year. Having other health
insurance coverage like Medicare, Medicaid, or private insurance
doesn’t affect getting VA healthcare benefits. Each veteran’s medical
benefits package is unique. Covered benefits depend on the 'priority
group' and the advice of the VA primary provider. Retiring veterans
may also be eligible for TRICARE. It is a Medicare-wraparound
coverage for those that have Medicare Part A and B.
There are two US government-run programs available to children
from low-income households. Depending on income level, they may
qualify for Medicaid or the Children’s Health Insurance Program
(CHIP). CHIP is a state-administered public program created in 1997
for children in low-income families that earn too much to qualify for
Medicaid but are unlikely to be able to afford private insurance. CHIP
is funded through matching grants from the federal government to the
states, and most states charge a low premium and have small copays,
if any. Because it is state-administered, exactly how it works varies by
state. For example, it is considered an extension of Medicaid in some
lOMoARcPSD|61746433
states, while in others it is a separate program. Currently, 9.6 million
children are covered by this program.
Coverage of Medications
In Japan, the coverage for medication for children, the unemployed,
and the retired remain under the same rules as the coinsurance
percentages. Clinics can dispense medication directly to the patients or
they can go to the pharmacy. According to the Commonwealth Fund,
the use of pharmacies has been growing. Price revisions for
medications are also revised every 2 years. Usually, prices are lowered
for new drugs that are selling more than expected, and for brand-name
drugs when their generic counterparts become available. Prices of
generic drugs have gradually decreased. Also, if a physician
prescribes more than 6 drugs regularly to a patient, he receives a
reduced fee as a way to improve clinical decision-making.
In the US, the coverage for medication for children, the unemployed,
the and retired depends on the coverage they have.
Retired individuals with Medicare have the option to purchase private
prescription drug coverage under Medicare Part D. Part D covers most
outpatient drugs, like those that you would get a prescription for and
pick up at the pharmacy. Medicare Part B only covers very limited
outpatient prescription drug benefits, like injections that need to be
given by a medical professional. For Medicare Part D, copays and
coinsurance vary by drug plan: $0–$5 for preferred generics, up to
50% for non-preferred drugs. For the unemployed that qualify for
Medicaid, outpatient prescription drugs are an optional benefit under
federal law, however, currently, all states provide drug coverage. For
children with private health insurance, the copay for prescriptions
lOMoARcPSD|61746433
depends on that specific insurance coverage. For low-income children,
the copay for medications is reduced if part of CHIP or possibly free if
on Medicaid. Vaccines are often free to uninsured and underinsured
children.
Referral to See a Specialist
In Japan, there is no 'gatekeeper'. Children, the unemployed, and the
retired do not need to get a referral to go see a specialist. The term
'general practice' in Japan is recent, but historically, there has been no
distinction between primary care and specialty care. The fee schedule
remains the same for all providers. Patients can see a specialist
without a referral and most of the time on a walk-in basis.
A 'gatekeeper' is very common for healthcare coverage in the United
States. American children, the unemployed, and the retired are often
limited to specialty services if it is not deemed necessary or they
cannot afford the excessive fees. PPO plans often can schedule an
appointment with a specialist without permission from their primary
care provider, but those with an HMO or government-sponsored plan
do not have that option. Outpatient specialists are free to choose which
form of insurance they will accept, or whether they will accept it at
all. For example, not all specialists accept publicly insured patients,
because of the relatively lower reimbursement rates set by Medicaid
and Medicare. Access to specialists for beneficiaries of these
programs—not to mention for people without any insurance—can
therefore be particularly limited.
Coverage for Preexisting Conditions
In Japan, no one can be excluded from any coverage based on a
preexisting condition. This also became true in the United States.
lOMoARcPSD|61746433
Under current law, health insurance companies can’t refuse to cover
you or charge you more just because you have a 'pre-existing
condition', that is, a health problem you had before the date that new
health coverage starts.
Finance Implications for Healthcare Delivery
In Japan, people benefit from the universal healthcare delivery system.
All fees are determined by the government and therefore controlled.
Even though most hospitals and medical offices are privately run, they
are limited on what they can charge based on government regulations.
This allows individuals to seek medical treatment and preventative
services more often, thus leading to better health. Not only is health
benefited but a person benefits financially as well. Unlike Americans,
the Japanese do not need to worry that paying for healthcare will lead
to financial ruin. A hospital stay is in the hundreds, whereas in the
United States, it is in the thousand and can leave a person bankrupt.
Americans often go without medical treatment simply based on the
fact that they cannot afford it. Especially if they do not have health
insurance, like in the circumstance of losing a job. In Japan, if a
person loses their job their health coverage just switches from the
employer to a community plan.
The negative financial implications of Japan’s healthcare structure fall
on the providers. 50% of hospitals are in financial deficit. This is the
opposite in America, where hospitals and doctors make a profit at the
expense of the people. In America private practices can, and often do,
refuse services to those with government-sponsored insurance like
Medicaid. This is mostly due to the low reimbursement and the length
of time to receive payment. This is not allowed in Japan. There are
lOMoARcPSD|61746433
also disincentives for providers prescribing certain medications or
services because the price is then lowered upon the next government
review of fees. Again, this benefits the consumer, not the provider.
In America, both public and private insurers determine their benefit
packages and cost-sharing structures as long as it is within federal and
state regulations. Private insurers in America are for-profit, while
Japan’s statutory health insurance system (SHIS) is a not-for-profit
system. Insurers in Japan are not out to make a profit. Anything
money not used is carried over to the next year, which could lead to
premiums being reduced.
Conclusion
In summary, the comparative analysis covered in this essay has shown
that the healthcare systems of Japan and America, although they share
some common features, are nevertheless different. As for me, I would
prefer the Japanese system, for its accessibility, simplicity, and
orientation for the benefit of its population.
The United States does not have a universal healthcare system. Health
care coverage in the United States is a mixture of public and private,
as well as for-profit and nonprofit insurers. Options include fee-for-
service (FFS), preferred provider organization (PPO), point of service
(POS), health maintenance organization (HMO), Medicare, Medicaid,
and coverage from the Veterans Health Administration. A majority of
US citizens have private insurance that is often provided through their
employer, or they may buy it on their own. 12.5% of US adults are
uninsured, and countless more are underinsured. Lack of health
insurance is perhaps the greatest barrier to accessing health care
lOMoARcPSD|61746433
services and has a tremendous negative effect on an individual’s
overall health status.
The only thing close to a universal healthcare system in the United
States is the Patient Protection and Affordable Care Act ( PPACA),
which was signed into law in 2010. Its goal was to expand health
insurance coverage to Americans that were uninsured while
controlling costs and improving the quality of healthcare. Since its
beginning, it has been under scrutiny, and many parts have been
amended, including removing the penalty fee for those that did not
have health insurance. With the implementation of the PPACA,
different plan options became available for people to obtain insurance,
but private insurance is the primary health coverage for two-thirds of
Americans (67%). Over half of all private insurance is through
employers. Most employer plans cover their employees and give
various options on the level of coverage and also the option to insure
their family. Rarely an employer pays the entire premium. Most of the
time the cost is shared between the employer and employee. Only
11% of private health insurance is purchased by individuals from for-
profit and nonprofit carriers.
In America, retirees/seniors qualify for Medicare. It is a complex fee-
for-service program consisting of parts, A-D. Part A provides hospital
insurance and Part B medical insurance. Members can choose to get
their coverage just through traditional Medicare, or they can choose to
enroll in Part C which is a private health maintenance organization
(HMO) called Medicare Advantage. Part D is also optional and is for
prescription drug coverage. Medicare is financed through a
lOMoARcPSD|61746433
combination of general federal taxes, a mandatory payroll tax that
pays for Part A, and individual premiums.
The unemployed may qualify for Medicaid if their income is low. It is
a jointly sponsored state and federal program that pays for medical
services for persons who are elderly, poor, blind, or disabled, and for
certain families with dependent children who meet specified income
guidelines. Medicaid is obtained through the state of residency. The
state then received federal matching for providing the health coverage.
Veterans can receive healthcare coverage from the Veterans Health
Administration. It is America’s largest integrated healthcare system
serving 9 million enrolled Veterans each year. Having other health
insurance coverage like Medicare, Medicaid, or private insurance
doesn’t affect getting VA healthcare benefits. Each veteran’s medical
benefits package is unique. Covered benefits depend on the 'priority
group' and the advice of the VA primary provider. Retiring veterans
may also be eligible for TRICARE. It is a Medicare-wraparound
coverage for those that have Medicare Part A and B.
There are two US government-run programs available to children
from low-income households. Depending on income level, they may
qualify for Medicaid or the Children’s Health Insurance Program
(CHIP). CHIP is a state-administered public program created in 1997
for children in low-income families that earn too much to qualify for
Medicaid but are unlikely to be able to afford private insurance. CHIP
is funded through matching grants from the federal government to the
states, and most states charge a low premium and have small copays,
if any. Because it is state-administered, exactly how it works varies by
state. For example, it is considered an extension of Medicaid in some
lOMoARcPSD|61746433
states, while in others it is a separate program. Currently, 9.6 million
children are covered by this program.
Coverage of Medications
In Japan, the coverage for medication for children, the unemployed,
and the retired remain under the same rules as the coinsurance
percentages. Clinics can dispense medication directly to the patients or
they can go to the pharmacy. According to the Commonwealth Fund,
the use of pharmacies has been growing. Price revisions for
medications are also revised every 2 years. Usually, prices are lowered
for new drugs that are selling more than expected, and for brand-name
drugs when their generic counterparts become available. Prices of
generic drugs have gradually decreased. Also, if a physician
prescribes more than 6 drugs regularly to a patient, he receives a
reduced fee as a way to improve clinical decision-making.
In the US, the coverage for medication for children, the unemployed,
the and retired depends on the coverage they have.
Retired individuals with Medicare have the option to purchase private
prescription drug coverage under Medicare Part D. Part D covers most
outpatient drugs, like those that you would get a prescription for and
pick up at the pharmacy. Medicare Part B only covers very limited
outpatient prescription drug benefits, like injections that need to be
given by a medical professional. For Medicare Part D, copays and
coinsurance vary by drug plan: $0–$5 for preferred generics, up to
50% for non-preferred drugs. For the unemployed that qualify for
Medicaid, outpatient prescription drugs are an optional benefit under
federal law, however, currently, all states provide drug coverage. For
children with private health insurance, the copay for prescriptions
lOMoARcPSD|61746433
depends on that specific insurance coverage. For low-income children,
the copay for medications is reduced if part of CHIP or possibly free if
on Medicaid. Vaccines are often free to uninsured and underinsured
children.
Referral to See a Specialist
In Japan, there is no 'gatekeeper'. Children, the unemployed, and the
retired do not need to get a referral to go see a specialist. The term
'general practice' in Japan is recent, but historically, there has been no
distinction between primary care and specialty care. The fee schedule
remains the same for all providers. Patients can see a specialist
without a referral and most of the time on a walk-in basis.
A 'gatekeeper' is very common for healthcare coverage in the United
States. American children, the unemployed, and the retired are often
limited to specialty services if it is not deemed necessary or they
cannot afford the excessive fees. PPO plans often can schedule an
appointment with a specialist without permission from their primary
care provider, but those with an HMO or government-sponsored plan
do not have that option. Outpatient specialists are free to choose which
form of insurance they will accept, or whether they will accept it at
all. For example, not all specialists accept publicly insured patients,
because of the relatively lower reimbursement rates set by Medicaid
and Medicare. Access to specialists for beneficiaries of these
programs—not to mention for people without any insurance—can
therefore be particularly limited.
Coverage for Preexisting Conditions
In Japan, no one can be excluded from any coverage based on a
preexisting condition. This also became true in the United States.
lOMoARcPSD|61746433
Under current law, health insurance companies can’t refuse to cover
you or charge you more just because you have a 'pre-existing
condition', that is, a health problem you had before the date that new
health coverage starts.
Finance Implications for Healthcare Delivery
In Japan, people benefit from the universal healthcare delivery system.
All fees are determined by the government and therefore controlled.
Even though most hospitals and medical offices are privately run, they
are limited on what they can charge based on government regulations.
This allows individuals to seek medical treatment and preventative
services more often, thus leading to better health. Not only is health
benefited but a person benefits financially as well. Unlike Americans,
the Japanese do not need to worry that paying for healthcare will lead
to financial ruin. A hospital stay is in the hundreds, whereas in the
United States, it is in the thousand and can leave a person bankrupt.
Americans often go without medical treatment simply based on the
fact that they cannot afford it. Especially if they do not have health
insurance, like in the circumstance of losing a job. In Japan, if a
person loses their job their health coverage just switches from the
employer to a community plan.
The negative financial implications of Japan’s healthcare structure fall
on the providers. 50% of hospitals are in financial deficit. This is the
opposite in America, where hospitals and doctors make a profit at the
expense of the people. In America private practices can, and often do,
refuse services to those with government-sponsored insurance like
Medicaid. This is mostly due to the low reimbursement and the length
of time to receive payment. This is not allowed in Japan. There are
lOMoARcPSD|61746433
also disincentives for providers prescribing certain medications or
services because the price is then lowered upon the next government
review of fees. Again, this benefits the consumer, not the provider.
In America, both public and private insurers determine their benefit
packages and cost-sharing structures as long as it is within federal and
state regulations. Private insurers in America are for-profit, while
Japan’s statutory health insurance system (SHIS) is a not-for-profit
system. Insurers in Japan are not out to make a profit. Anything
money not used is carried over to the next year, which could lead to
premiums being reduced.
Conclusion
In summary, the comparative analysis covered in this essay has shown
that the healthcare systems of Japan and America, although they share
some common features, are nevertheless different. As for me, I would
prefer the Japanese system, for its accessibility, simplicity, and
orientation for the benefit of its population.
The United States does not have a universal healthcare system. Health
care coverage in the United States is a mixture of public and private,
as well as for-profit and nonprofit insurers. Options include fee-for-
service (FFS), preferred provider organization (PPO), point of service
(POS), health maintenance organization (HMO), Medicare, Medicaid,
and coverage from the Veterans Health Administration. A majority of
US citizens have private insurance that is often provided through their
employer, or they may buy it on their own. 12.5% of US adults are
uninsured, and countless more are underinsured. Lack of health
insurance is perhaps the greatest barrier to accessing health care
lOMoARcPSD|61746433
services and has a tremendous negative effect on an individual’s
overall health status.
The only thing close to a universal healthcare system in the United
States is the Patient Protection and Affordable Care Act ( PPACA),
which was signed into law in 2010. Its goal was to expand health
insurance coverage to Americans that were uninsured while
controlling costs and improving the quality of healthcare. Since its
beginning, it has been under scrutiny, and many parts have been
amended, including removing the penalty fee for those that did not
have health insurance. With the implementation of the PPACA,
different plan options became available for people to obtain insurance,
but private insurance is the primary health coverage for two-thirds of
Americans (67%). Over half of all private insurance is through
employers. Most employer plans cover their employees and give
various options on the level of coverage and also the option to insure
their family. Rarely an employer pays the entire premium. Most of the
time the cost is shared between the employer and employee. Only
11% of private health insurance is purchased by individuals from for-
profit and nonprofit carriers.
In America, retirees/seniors qualify for Medicare. It is a complex fee-
for-service program consisting of parts, A-D. Part A provides hospital
insurance and Part B medical insurance. Members can choose to get
their coverage just through traditional Medicare, or they can choose to
enroll in Part C which is a private health maintenance organization
(HMO) called Medicare Advantage. Part D is also optional and is for
prescription drug coverage. Medicare is financed through a
lOMoARcPSD|61746433
combination of general federal taxes, a mandatory payroll tax that
pays for Part A, and individual premiums.
The unemployed may qualify for Medicaid if their income is low. It is
a jointly sponsored state and federal program that pays for medical
services for persons who are elderly, poor, blind, or disabled, and for
certain families with dependent children who meet specified income
guidelines. Medicaid is obtained through the state of residency. The
state then received federal matching for providing the health coverage.
Veterans can receive healthcare coverage from the Veterans Health
Administration. It is America’s largest integrated healthcare system
serving 9 million enrolled Veterans each year. Having other health
insurance coverage like Medicare, Medicaid, or private insurance
doesn’t affect getting VA healthcare benefits. Each veteran’s medical
benefits package is unique. Covered benefits depend on the 'priority
group' and the advice of the VA primary provider. Retiring veterans
may also be eligible for TRICARE. It is a Medicare-wraparound
coverage for those that have Medicare Part A and B.
There are two US government-run programs available to children
from low-income households. Depending on income level, they may
qualify for Medicaid or the Children’s Health Insurance Program
(CHIP). CHIP is a state-administered public program created in 1997
for children in low-income families that earn too much to qualify for
Medicaid but are unlikely to be able to afford private insurance. CHIP
is funded through matching grants from the federal government to the
states, and most states charge a low premium and have small copays,
if any. Because it is state-administered, exactly how it works varies by
state. For example, it is considered an extension of Medicaid in some
lOMoARcPSD|61746433
states, while in others it is a separate program. Currently, 9.6 million
children are covered by this program.
Coverage of Medications
In Japan, the coverage for medication for children, the unemployed,
and the retired remain under the same rules as the coinsurance
percentages. Clinics can dispense medication directly to the patients or
they can go to the pharmacy. According to the Commonwealth Fund,
the use of pharmacies has been growing. Price revisions for
medications are also revised every 2 years. Usually, prices are lowered
for new drugs that are selling more than expected, and for brand-name
drugs when their generic counterparts become available. Prices of
generic drugs have gradually decreased. Also, if a physician
prescribes more than 6 drugs regularly to a patient, he receives a
reduced fee as a way to improve clinical decision-making.
In the US, the coverage for medication for children, the unemployed,
the and retired depends on the coverage they have.
Retired individuals with Medicare have the option to purchase private
prescription drug coverage under Medicare Part D. Part D covers most
outpatient drugs, like those that you would get a prescription for and
pick up at the pharmacy. Medicare Part B only covers very limited
outpatient prescription drug benefits, like injections that need to be
given by a medical professional. For Medicare Part D, copays and
coinsurance vary by drug plan: $0–$5 for preferred generics, up to
50% for non-preferred drugs. For the unemployed that qualify for
Medicaid, outpatient prescription drugs are an optional benefit under
federal law, however, currently, all states provide drug coverage. For
children with private health insurance, the copay for prescriptions
lOMoARcPSD|61746433
depends on that specific insurance coverage. For low-income children,
the copay for medications is reduced if part of CHIP or possibly free if
on Medicaid. Vaccines are often free to uninsured and underinsured
children.
Referral to See a Specialist
In Japan, there is no 'gatekeeper'. Children, the unemployed, and the
retired do not need to get a referral to go see a specialist. The term
'general practice' in Japan is recent, but historically, there has been no
distinction between primary care and specialty care. The fee schedule
remains the same for all providers. Patients can see a specialist
without a referral and most of the time on a walk-in basis.
A 'gatekeeper' is very common for healthcare coverage in the United
States. American children, the unemployed, and the retired are often
limited to specialty services if it is not deemed necessary or they
cannot afford the excessive fees. PPO plans often can schedule an
appointment with a specialist without permission from their primary
care provider, but those with an HMO or government-sponsored plan
do not have that option. Outpatient specialists are free to choose which
form of insurance they will accept, or whether they will accept it at
all. For example, not all specialists accept publicly insured patients,
because of the relatively lower reimbursement rates set by Medicaid
and Medicare. Access to specialists for beneficiaries of these
programs—not to mention for people without any insurance—can
therefore be particularly limited.
Coverage for Preexisting Conditions
In Japan, no one can be excluded from any coverage based on a
preexisting condition. This also became true in the United States.
lOMoARcPSD|61746433
Under current law, health insurance companies can’t refuse to cover
you or charge you more just because you have a 'pre-existing
condition', that is, a health problem you had before the date that new
health coverage starts.
Finance Implications for Healthcare Delivery
In Japan, people benefit from the universal healthcare delivery system.
All fees are determined by the government and therefore controlled.
Even though most hospitals and medical offices are privately run, they
are limited on what they can charge based on government regulations.
This allows individuals to seek medical treatment and preventative
services more often, thus leading to better health. Not only is health
benefited but a person benefits financially as well. Unlike Americans,
the Japanese do not need to worry that paying for healthcare will lead
to financial ruin. A hospital stay is in the hundreds, whereas in the
United States, it is in the thousand and can leave a person bankrupt.
Americans often go without medical treatment simply based on the
fact that they cannot afford it. Especially if they do not have health
insurance, like in the circumstance of losing a job. In Japan, if a
person loses their job their health coverage just switches from the
employer to a community plan.
The negative financial implications of Japan’s healthcare structure fall
on the providers. 50% of hospitals are in financial deficit. This is the
opposite in America, where hospitals and doctors make a profit at the
expense of the people. In America private practices can, and often do,
refuse services to those with government-sponsored insurance like
Medicaid. This is mostly due to the low reimbursement and the length
of time to receive payment. This is not allowed in Japan. There are
lOMoARcPSD|61746433
also disincentives for providers prescribing certain medications or
services because the price is then lowered upon the next government
review of fees. Again, this benefits the consumer, not the provider.
In America, both public and private insurers determine their benefit
packages and cost-sharing structures as long as it is within federal and
state regulations. Private insurers in America are for-profit, while
Japan’s statutory health insurance system (SHIS) is a not-for-profit
system. Insurers in Japan are not out to make a profit. Anything
money not used is carried over to the next year, which could lead to
premiums being reduced.
Conclusion
In summary, the comparative analysis covered in this essay has shown
that the healthcare systems of Japan and America, although they share
some common features, are nevertheless different. As for me, I would
prefer the Japanese system, for its accessibility, simplicity, and
orientation for the benefit of its population.
The United States does not have a universal healthcare system. Health
care coverage in the United States is a mixture of public and private,
as well as for-profit and nonprofit insurers. Options include fee-for-
service (FFS), preferred provider organization (PPO), point of service
(POS), health maintenance organization (HMO), Medicare, Medicaid,
and coverage from the Veterans Health Administration. A majority of
US citizens have private insurance that is often provided through their
employer, or they may buy it on their own. 12.5% of US adults are
uninsured, and countless more are underinsured. Lack of health
insurance is perhaps the greatest barrier to accessing health care
lOMoARcPSD|61746433
services and has a tremendous negative effect on an individual’s
overall health status.
The only thing close to a universal healthcare system in the United
States is the Patient Protection and Affordable Care Act ( PPACA),
which was signed into law in 2010. Its goal was to expand health
insurance coverage to Americans that were uninsured while
controlling costs and improving the quality of healthcare. Since its
beginning, it has been under scrutiny, and many parts have been
amended, including removing the penalty fee for those that did not
have health insurance. With the implementation of the PPACA,
different plan options became available for people to obtain insurance,
but private insurance is the primary health coverage for two-thirds of
Americans (67%). Over half of all private insurance is through
employers. Most employer plans cover their employees and give
various options on the level of coverage and also the option to insure
their family. Rarely an employer pays the entire premium. Most of the
time the cost is shared between the employer and employee. Only
11% of private health insurance is purchased by individuals from for-
profit and nonprofit carriers.
In America, retirees/seniors qualify for Medicare. It is a complex fee-
for-service program consisting of parts, A-D. Part A provides hospital
insurance and Part B medical insurance. Members can choose to get
their coverage just through traditional Medicare, or they can choose to
enroll in Part C which is a private health maintenance organization
(HMO) called Medicare Advantage. Part D is also optional and is for
prescription drug coverage. Medicare is financed through a
lOMoARcPSD|61746433
combination of general federal taxes, a mandatory payroll tax that
pays for Part A, and individual premiums.
The unemployed may qualify for Medicaid if their income is low. It is
a jointly sponsored state and federal program that pays for medical
services for persons who are elderly, poor, blind, or disabled, and for
certain families with dependent children who meet specified income
guidelines. Medicaid is obtained through the state of residency. The
state then received federal matching for providing the health coverage.
Veterans can receive healthcare coverage from the Veterans Health
Administration. It is America’s largest integrated healthcare system
serving 9 million enrolled Veterans each year. Having other health
insurance coverage like Medicare, Medicaid, or private insurance
doesn’t affect getting VA healthcare benefits. Each veteran’s medical
benefits package is unique. Covered benefits depend on the 'priority
group' and the advice of the VA primary provider. Retiring veterans
may also be eligible for TRICARE. It is a Medicare-wraparound
coverage for those that have Medicare Part A and B.
There are two US government-run programs available to children
from low-income households. Depending on income level, they may
qualify for Medicaid or the Children’s Health Insurance Program
(CHIP). CHIP is a state-administered public program created in 1997
for children in low-income families that earn too much to qualify for
Medicaid but are unlikely to be able to afford private insurance. CHIP
is funded through matching grants from the federal government to the
states, and most states charge a low premium and have small copays,
if any. Because it is state-administered, exactly how it works varies by
state. For example, it is considered an extension of Medicaid in some
lOMoARcPSD|61746433
states, while in others it is a separate program. Currently, 9.6 million
children are covered by this program.
Coverage of Medications
In Japan, the coverage for medication for children, the unemployed,
and the retired remain under the same rules as the coinsurance
percentages. Clinics can dispense medication directly to the patients or
they can go to the pharmacy. According to the Commonwealth Fund,
the use of pharmacies has been growing. Price revisions for
medications are also revised every 2 years. Usually, prices are lowered
for new drugs that are selling more than expected, and for brand-name
drugs when their generic counterparts become available. Prices of
generic drugs have gradually decreased. Also, if a physician
prescribes more than 6 drugs regularly to a patient, he receives a
reduced fee as a way to improve clinical decision-making.
In the US, the coverage for medication for children, the unemployed,
the and retired depends on the coverage they have.
Retired individuals with Medicare have the option to purchase private
prescription drug coverage under Medicare Part D. Part D covers most
outpatient drugs, like those that you would get a prescription for and
pick up at the pharmacy. Medicare Part B only covers very limited
outpatient prescription drug benefits, like injections that need to be
given by a medical professional. For Medicare Part D, copays and
coinsurance vary by drug plan: $0–$5 for preferred generics, up to
50% for non-preferred drugs. For the unemployed that qualify for
Medicaid, outpatient prescription drugs are an optional benefit under
federal law, however, currently, all states provide drug coverage. For
children with private health insurance, the copay for prescriptions
lOMoARcPSD|61746433
depends on that specific insurance coverage. For low-income children,
the copay for medications is reduced if part of CHIP or possibly free if
on Medicaid. Vaccines are often free to uninsured and underinsured
children.
Referral to See a Specialist
In Japan, there is no 'gatekeeper'. Children, the unemployed, and the
retired do not need to get a referral to go see a specialist. The term
'general practice' in Japan is recent, but historically, there has been no
distinction between primary care and specialty care. The fee schedule
remains the same for all providers. Patients can see a specialist
without a referral and most of the time on a walk-in basis.
A 'gatekeeper' is very common for healthcare coverage in the United
States. American children, the unemployed, and the retired are often
limited to specialty services if it is not deemed necessary or they
cannot afford the excessive fees. PPO plans often can schedule an
appointment with a specialist without permission from their primary
care provider, but those with an HMO or government-sponsored plan
do not have that option. Outpatient specialists are free to choose which
form of insurance they will accept, or whether they will accept it at
all. For example, not all specialists accept publicly insured patients,
because of the relatively lower reimbursement rates set by Medicaid
and Medicare. Access to specialists for beneficiaries of these
programs—not to mention for people without any insurance—can
therefore be particularly limited.
Coverage for Preexisting Conditions
In Japan, no one can be excluded from any coverage based on a
preexisting condition. This also became true in the United States.
lOMoARcPSD|61746433
Under current law, health insurance companies can’t refuse to cover
you or charge you more just because you have a 'pre-existing
condition', that is, a health problem you had before the date that new
health coverage starts.
Finance Implications for Healthcare Delivery
In Japan, people benefit from the universal healthcare delivery system.
All fees are determined by the government and therefore controlled.
Even though most hospitals and medical offices are privately run, they
are limited on what they can charge based on government regulations.
This allows individuals to seek medical treatment and preventative
services more often, thus leading to better health. Not only is health
benefited but a person benefits financially as well. Unlike Americans,
the Japanese do not need to worry that paying for healthcare will lead
to financial ruin. A hospital stay is in the hundreds, whereas in the
United States, it is in the thousand and can leave a person bankrupt.
Americans often go without medical treatment simply based on the
fact that they cannot afford it. Especially if they do not have health
insurance, like in the circumstance of losing a job. In Japan, if a
person loses their job their health coverage just switches from the
employer to a community plan.
The negative financial implications of Japan’s healthcare structure fall
on the providers. 50% of hospitals are in financial deficit. This is the
opposite in America, where hospitals and doctors make a profit at the
expense of the people. In America private practices can, and often do,
refuse services to those with government-sponsored insurance like
Medicaid. This is mostly due to the low reimbursement and the length
of time to receive payment. This is not allowed in Japan. There are
lOMoARcPSD|61746433
also disincentives for providers prescribing certain medications or
services because the price is then lowered upon the next government
review of fees. Again, this benefits the consumer, not the provider.
In America, both public and private insurers determine their benefit
packages and cost-sharing structures as long as it is within federal and
state regulations. Private insurers in America are for-profit, while
Japan’s statutory health insurance system (SHIS) is a not-for-profit
system. Insurers in Japan are not out to make a profit. Anything
money not used is carried over to the next year, which could lead to
premiums being reduced.
Conclusion
In summary, the comparative analysis covered in this essay has shown
that the healthcare systems of Japan and America, although they share
some common features, are nevertheless different. As for me, I would
prefer the Japanese system, for its accessibility, simplicity, and
orientation for the benefit of its population.
The United States does not have a universal healthcare system. Health
care coverage in the United States is a mixture of public and private,
as well as for-profit and nonprofit insurers. Options include fee-for-
service (FFS), preferred provider organization (PPO), point of service
(POS), health maintenance organization (HMO), Medicare, Medicaid,
and coverage from the Veterans Health Administration. A majority of
US citizens have private insurance that is often provided through their
employer, or they may buy it on their own. 12.5% of US adults are
uninsured, and countless more are underinsured. Lack of health
insurance is perhaps the greatest barrier to accessing health care
lOMoARcPSD|61746433
services and has a tremendous negative effect on an individual’s
overall health status.
The only thing close to a universal healthcare system in the United
States is the Patient Protection and Affordable Care Act ( PPACA),
which was signed into law in 2010. Its goal was to expand health
insurance coverage to Americans that were uninsured while
controlling costs and improving the quality of healthcare. Since its
beginning, it has been under scrutiny, and many parts have been
amended, including removing the penalty fee for those that did not
have health insurance. With the implementation of the PPACA,
different plan options became available for people to obtain insurance,
but private insurance is the primary health coverage for two-thirds of
Americans (67%). Over half of all private insurance is through
employers. Most employer plans cover their employees and give
various options on the level of coverage and also the option to insure
their family. Rarely an employer pays the entire premium. Most of the
time the cost is shared between the employer and employee. Only
11% of private health insurance is purchased by individuals from for-
profit and nonprofit carriers.
In America, retirees/seniors qualify for Medicare. It is a complex fee-
for-service program consisting of parts, A-D. Part A provides hospital
insurance and Part B medical insurance. Members can choose to get
their coverage just through traditional Medicare, or they can choose to
enroll in Part C which is a private health maintenance organization
(HMO) called Medicare Advantage. Part D is also optional and is for
prescription drug coverage. Medicare is financed through a
lOMoARcPSD|61746433
combination of general federal taxes, a mandatory payroll tax that
pays for Part A, and individual premiums.
The unemployed may qualify for Medicaid if their income is low. It is
a jointly sponsored state and federal program that pays for medical
services for persons who are elderly, poor, blind, or disabled, and for
certain families with dependent children who meet specified income
guidelines. Medicaid is obtained through the state of residency. The
state then received federal matching for providing the health coverage.
Veterans can receive healthcare coverage from the Veterans Health
Administration. It is America’s largest integrated healthcare system
serving 9 million enrolled Veterans each year. Having other health
insurance coverage like Medicare, Medicaid, or private insurance
doesn’t affect getting VA healthcare benefits. Each veteran’s medical
benefits package is unique. Covered benefits depend on the 'priority
group' and the advice of the VA primary provider. Retiring veterans
may also be eligible for TRICARE. It is a Medicare-wraparound
coverage for those that have Medicare Part A and B.
There are two US government-run programs available to children
from low-income households. Depending on income level, they may
qualify for Medicaid or the Children’s Health Insurance Program
(CHIP). CHIP is a state-administered public program created in 1997
for children in low-income families that earn too much to qualify for
Medicaid but are unlikely to be able to afford private insurance. CHIP
is funded through matching grants from the federal government to the
states, and most states charge a low premium and have small copays,
if any. Because it is state-administered, exactly how it works varies by
state. For example, it is considered an extension of Medicaid in some
lOMoARcPSD|61746433
states, while in others it is a separate program. Currently, 9.6 million
children are covered by this program.
Coverage of Medications
In Japan, the coverage for medication for children, the unemployed,
and the retired remain under the same rules as the coinsurance
percentages. Clinics can dispense medication directly to the patients or
they can go to the pharmacy. According to the Commonwealth Fund,
the use of pharmacies has been growing. Price revisions for
medications are also revised every 2 years. Usually, prices are lowered
for new drugs that are selling more than expected, and for brand-name
drugs when their generic counterparts become available. Prices of
generic drugs have gradually decreased. Also, if a physician
prescribes more than 6 drugs regularly to a patient, he receives a
reduced fee as a way to improve clinical decision-making.
In the US, the coverage for medication for children, the unemployed,
the and retired depends on the coverage they have.
Retired individuals with Medicare have the option to purchase private
prescription drug coverage under Medicare Part D. Part D covers most
outpatient drugs, like those that you would get a prescription for and
pick up at the pharmacy. Medicare Part B only covers very limited
outpatient prescription drug benefits, like injections that need to be
given by a medical professional. For Medicare Part D, copays and
coinsurance vary by drug plan: $0–$5 for preferred generics, up to
50% for non-preferred drugs. For the unemployed that qualify for
Medicaid, outpatient prescription drugs are an optional benefit under
federal law, however, currently, all states provide drug coverage. For
children with private health insurance, the copay for prescriptions
lOMoARcPSD|61746433
depends on that specific insurance coverage. For low-income children,
the copay for medications is reduced if part of CHIP or possibly free if
on Medicaid. Vaccines are often free to uninsured and underinsured
children.
Referral to See a Specialist
In Japan, there is no 'gatekeeper'. Children, the unemployed, and the
retired do not need to get a referral to go see a specialist. The term
'general practice' in Japan is recent, but historically, there has been no
distinction between primary care and specialty care. The fee schedule
remains the same for all providers. Patients can see a specialist
without a referral and most of the time on a walk-in basis.
A 'gatekeeper' is very common for healthcare coverage in the United
States. American children, the unemployed, and the retired are often
limited to specialty services if it is not deemed necessary or they
cannot afford the excessive fees. PPO plans often can schedule an
appointment with a specialist without permission from their primary
care provider, but those with an HMO or government-sponsored plan
do not have that option. Outpatient specialists are free to choose which
form of insurance they will accept, or whether they will accept it at
all. For example, not all specialists accept publicly insured patients,
because of the relatively lower reimbursement rates set by Medicaid
and Medicare. Access to specialists for beneficiaries of these
programs—not to mention for people without any insurance—can
therefore be particularly limited.
Coverage for Preexisting Conditions
In Japan, no one can be excluded from any coverage based on a
preexisting condition. This also became true in the United States.
lOMoARcPSD|61746433
Under current law, health insurance companies can’t refuse to cover
you or charge you more just because you have a 'pre-existing
condition', that is, a health problem you had before the date that new
health coverage starts.
Finance Implications for Healthcare Delivery
In Japan, people benefit from the universal healthcare delivery system.
All fees are determined by the government and therefore controlled.
Even though most hospitals and medical offices are privately run, they
are limited on what they can charge based on government regulations.
This allows individuals to seek medical treatment and preventative
services more often, thus leading to better health. Not only is health
benefited but a person benefits financially as well. Unlike Americans,
the Japanese do not need to worry that paying for healthcare will lead
to financial ruin. A hospital stay is in the hundreds, whereas in the
United States, it is in the thousand and can leave a person bankrupt.
Americans often go without medical treatment simply based on the
fact that they cannot afford it. Especially if they do not have health
insurance, like in the circumstance of losing a job. In Japan, if a
person loses their job their health coverage just switches from the
employer to a community plan.
The negative financial implications of Japan’s healthcare structure fall
on the providers. 50% of hospitals are in financial deficit. This is the
opposite in America, where hospitals and doctors make a profit at the
expense of the people. In America private practices can, and often do,
refuse services to those with government-sponsored insurance like
Medicaid. This is mostly due to the low reimbursement and the length
of time to receive payment. This is not allowed in Japan. There are
lOMoARcPSD|61746433
also disincentives for providers prescribing certain medications or
services because the price is then lowered upon the next government
review of fees. Again, this benefits the consumer, not the provider.
In America, both public and private insurers determine their benefit
packages and cost-sharing structures as long as it is within federal and
state regulations. Private insurers in America are for-profit, while
Japan’s statutory health insurance system (SHIS) is a not-for-profit
system. Insurers in Japan are not out to make a profit. Anything
money not used is carried over to the next year, which could lead to
premiums being reduced.
Conclusion
In summary, the comparative analysis covered in this essay has shown
that the healthcare systems of Japan and America, although they share
some common features, are nevertheless different. As for me, I would
prefer the Japanese system, for its accessibility, simplicity, and
orientation for the benefit of its population.
The United States does not have a universal healthcare system. Health
care coverage in the United States is a mixture of public and private,
as well as for-profit and nonprofit insurers. Options include fee-for-
service (FFS), preferred provider organization (PPO), point of service
(POS), health maintenance organization (HMO), Medicare, Medicaid,
and coverage from the Veterans Health Administration. A majority of
US citizens have private insurance that is often provided through their
employer, or they may buy it on their own. 12.5% of US adults are
uninsured, and countless more are underinsured. Lack of health
insurance is perhaps the greatest barrier to accessing health care
lOMoARcPSD|61746433
services and has a tremendous negative effect on an individual’s
overall health status.
The only thing close to a universal healthcare system in the United
States is the Patient Protection and Affordable Care Act ( PPACA),
which was signed into law in 2010. Its goal was to expand health
insurance coverage to Americans that were uninsured while
controlling costs and improving the quality of healthcare. Since its
beginning, it has been under scrutiny, and many parts have been
amended, including removing the penalty fee for those that did not
have health insurance. With the implementation of the PPACA,
different plan options became available for people to obtain insurance,
but private insurance is the primary health coverage for two-thirds of
Americans (67%). Over half of all private insurance is through
employers. Most employer plans cover their employees and give
various options on the level of coverage and also the option to insure
their family. Rarely an employer pays the entire premium. Most of the
time the cost is shared between the employer and employee. Only
11% of private health insurance is purchased by individuals from for-
profit and nonprofit carriers.
In America, retirees/seniors qualify for Medicare. It is a complex fee-
for-service program consisting of parts, A-D. Part A provides hospital
insurance and Part B medical insurance. Members can choose to get
their coverage just through traditional Medicare, or they can choose to
enroll in Part C which is a private health maintenance organization
(HMO) called Medicare Advantage. Part D is also optional and is for
prescription drug coverage. Medicare is financed through a
lOMoARcPSD|61746433
combination of general federal taxes, a mandatory payroll tax that
pays for Part A, and individual premiums.
The unemployed may qualify for Medicaid if their income is low. It is
a jointly sponsored state and federal program that pays for medical
services for persons who are elderly, poor, blind, or disabled, and for
certain families with dependent children who meet specified income
guidelines. Medicaid is obtained through the state of residency. The
state then received federal matching for providing the health coverage.
Veterans can receive healthcare coverage from the Veterans Health
Administration. It is America’s largest integrated healthcare system
serving 9 million enrolled Veterans each year. Having other health
insurance coverage like Medicare, Medicaid, or private insurance
doesn’t affect getting VA healthcare benefits. Each veteran’s medical
benefits package is unique. Covered benefits depend on the 'priority
group' and the advice of the VA primary provider. Retiring veterans
may also be eligible for TRICARE. It is a Medicare-wraparound
coverage for those that have Medicare Part A and B.
There are two US government-run programs available to children
from low-income households. Depending on income level, they may
qualify for Medicaid or the Children’s Health Insurance Program
(CHIP). CHIP is a state-administered public program created in 1997
for children in low-income families that earn too much to qualify for
Medicaid but are unlikely to be able to afford private insurance. CHIP
is funded through matching grants from the federal government to the
states, and most states charge a low premium and have small copays,
if any. Because it is state-administered, exactly how it works varies by
state. For example, it is considered an extension of Medicaid in some
lOMoARcPSD|61746433
states, while in others it is a separate program. Currently, 9.6 million
children are covered by this program.
Coverage of Medications
In Japan, the coverage for medication for children, the unemployed,
and the retired remain under the same rules as the coinsurance
percentages. Clinics can dispense medication directly to the patients or
they can go to the pharmacy. According to the Commonwealth Fund,
the use of pharmacies has been growing. Price revisions for
medications are also revised every 2 years. Usually, prices are lowered
for new drugs that are selling more than expected, and for brand-name
drugs when their generic counterparts become available. Prices of
generic drugs have gradually decreased. Also, if a physician
prescribes more than 6 drugs regularly to a patient, he receives a
reduced fee as a way to improve clinical decision-making.
In the US, the coverage for medication for children, the unemployed,
the and retired depends on the coverage they have.
Retired individuals with Medicare have the option to purchase private
prescription drug coverage under Medicare Part D. Part D covers most
outpatient drugs, like those that you would get a prescription for and
pick up at the pharmacy. Medicare Part B only covers very limited
outpatient prescription drug benefits, like injections that need to be
given by a medical professional. For Medicare Part D, copays and
coinsurance vary by drug plan: $0–$5 for preferred generics, up to
50% for non-preferred drugs. For the unemployed that qualify for
Medicaid, outpatient prescription drugs are an optional benefit under
federal law, however, currently, all states provide drug coverage. For
children with private health insurance, the copay for prescriptions
lOMoARcPSD|61746433
depends on that specific insurance coverage. For low-income children,
the copay for medications is reduced if part of CHIP or possibly free if
on Medicaid. Vaccines are often free to uninsured and underinsured
children.
Referral to See a Specialist
In Japan, there is no 'gatekeeper'. Children, the unemployed, and the
retired do not need to get a referral to go see a specialist. The term
'general practice' in Japan is recent, but historically, there has been no
distinction between primary care and specialty care. The fee schedule
remains the same for all providers. Patients can see a specialist
without a referral and most of the time on a walk-in basis.
A 'gatekeeper' is very common for healthcare coverage in the United
States. American children, the unemployed, and the retired are often
limited to specialty services if it is not deemed necessary or they
cannot afford the excessive fees. PPO plans often can schedule an
appointment with a specialist without permission from their primary
care provider, but those with an HMO or government-sponsored plan
do not have that option. Outpatient specialists are free to choose which
form of insurance they will accept, or whether they will accept it at
all. For example, not all specialists accept publicly insured patients,
because of the relatively lower reimbursement rates set by Medicaid
and Medicare. Access to specialists for beneficiaries of these
programs—not to mention for people without any insurance—can
therefore be particularly limited.
Coverage for Preexisting Conditions
In Japan, no one can be excluded from any coverage based on a
preexisting condition. This also became true in the United States.
lOMoARcPSD|61746433
Under current law, health insurance companies can’t refuse to cover
you or charge you more just because you have a 'pre-existing
condition', that is, a health problem you had before the date that new
health coverage starts.
Finance Implications for Healthcare Delivery
In Japan, people benefit from the universal healthcare delivery system.
All fees are determined by the government and therefore controlled.
Even though most hospitals and medical offices are privately run, they
are limited on what they can charge based on government regulations.
This allows individuals to seek medical treatment and preventative
services more often, thus leading to better health. Not only is health
benefited but a person benefits financially as well. Unlike Americans,
the Japanese do not need to worry that paying for healthcare will lead
to financial ruin. A hospital stay is in the hundreds, whereas in the
United States, it is in the thousand and can leave a person bankrupt.
Americans often go without medical treatment simply based on the
fact that they cannot afford it. Especially if they do not have health
insurance, like in the circumstance of losing a job. In Japan, if a
person loses their job their health coverage just switches from the
employer to a community plan.
The negative financial implications of Japan’s healthcare structure fall
on the providers. 50% of hospitals are in financial deficit. This is the
opposite in America, where hospitals and doctors make a profit at the
expense of the people. In America private practices can, and often do,
refuse services to those with government-sponsored insurance like
Medicaid. This is mostly due to the low reimbursement and the length
of time to receive payment. This is not allowed in Japan. There are
lOMoARcPSD|61746433
also disincentives for providers prescribing certain medications or
services because the price is then lowered upon the next government
review of fees. Again, this benefits the consumer, not the provider.
In America, both public and private insurers determine their benefit
packages and cost-sharing structures as long as it is within federal and
state regulations. Private insurers in America are for-profit, while
Japan’s statutory health insurance system (SHIS) is a not-for-profit
system. Insurers in Japan are not out to make a profit. Anything
money not used is carried over to the next year, which could lead to
premiums being reduced.
Conclusion
In summary, the comparative analysis covered in this essay has shown
that the healthcare systems of Japan and America, although they share
some common features, are nevertheless different. As for me, I would
prefer the Japanese system, for its accessibility, simplicity, and
orientation for the benefit of its population.
The United States does not have a universal healthcare system. Health
care coverage in the United States is a mixture of public and private,
as well as for-profit and nonprofit insurers. Options include fee-for-
service (FFS), preferred provider organization (PPO), point of service
(POS), health maintenance organization (HMO), Medicare, Medicaid,
and coverage from the Veterans Health Administration. A majority of
US citizens have private insurance that is often provided through their
employer, or they may buy it on their own. 12.5% of US adults are
uninsured, and countless more are underinsured. Lack of health
insurance is perhaps the greatest barrier to accessing health care
lOMoARcPSD|61746433
services and has a tremendous negative effect on an individual’s
overall health status.
The only thing close to a universal healthcare system in the United
States is the Patient Protection and Affordable Care Act ( PPACA),
which was signed into law in 2010. Its goal was to expand health
insurance coverage to Americans that were uninsured while
controlling costs and improving the quality of healthcare. Since its
beginning, it has been under scrutiny, and many parts have been
amended, including removing the penalty fee for those that did not
have health insurance. With the implementation of the PPACA,
different plan options became available for people to obtain insurance,
but private insurance is the primary health coverage for two-thirds of
Americans (67%). Over half of all private insurance is through
employers. Most employer plans cover their employees and give
various options on the level of coverage and also the option to insure
their family. Rarely an employer pays the entire premium. Most of the
time the cost is shared between the employer and employee. Only
11% of private health insurance is purchased by individuals from for-
profit and nonprofit carriers.
In America, retirees/seniors qualify for Medicare. It is a complex fee-
for-service program consisting of parts, A-D. Part A provides hospital
insurance and Part B medical insurance. Members can choose to get
their coverage just through traditional Medicare, or they can choose to
enroll in Part C which is a private health maintenance organization
(HMO) called Medicare Advantage. Part D is also optional and is for
prescription drug coverage. Medicare is financed through a
lOMoARcPSD|61746433
combination of general federal taxes, a mandatory payroll tax that
pays for Part A, and individual premiums.
The unemployed may qualify for Medicaid if their income is low. It is
a jointly sponsored state and federal program that pays for medical
services for persons who are elderly, poor, blind, or disabled, and for
certain families with dependent children who meet specified income
guidelines. Medicaid is obtained through the state of residency. The
state then received federal matching for providing the health coverage.
Veterans can receive healthcare coverage from the Veterans Health
Administration. It is America’s largest integrated healthcare system
serving 9 million enrolled Veterans each year. Having other health
insurance coverage like Medicare, Medicaid, or private insurance
doesn’t affect getting VA healthcare benefits. Each veteran’s medical
benefits package is unique. Covered benefits depend on the 'priority
group' and the advice of the VA primary provider. Retiring veterans
may also be eligible for TRICARE. It is a Medicare-wraparound
coverage for those that have Medicare Part A and B.
There are two US government-run programs available to children
from low-income households. Depending on income level, they may
qualify for Medicaid or the Children’s Health Insurance Program
(CHIP). CHIP is a state-administered public program created in 1997
for children in low-income families that earn too much to qualify for
Medicaid but are unlikely to be able to afford private insurance. CHIP
is funded through matching grants from the federal government to the
states, and most states charge a low premium and have small copays,
if any. Because it is state-administered, exactly how it works varies by
state. For example, it is considered an extension of Medicaid in some
lOMoARcPSD|61746433
states, while in others it is a separate program. Currently, 9.6 million
children are covered by this program.
Coverage of Medications
In Japan, the coverage for medication for children, the unemployed,
and the retired remain under the same rules as the coinsurance
percentages. Clinics can dispense medication directly to the patients or
they can go to the pharmacy. According to the Commonwealth Fund,
the use of pharmacies has been growing. Price revisions for
medications are also revised every 2 years. Usually, prices are lowered
for new drugs that are selling more than expected, and for brand-name
drugs when their generic counterparts become available. Prices of
generic drugs have gradually decreased. Also, if a physician
prescribes more than 6 drugs regularly to a patient, he receives a
reduced fee as a way to improve clinical decision-making.
In the US, the coverage for medication for children, the unemployed,
the and retired depends on the coverage they have.
Retired individuals with Medicare have the option to purchase private
prescription drug coverage under Medicare Part D. Part D covers most
outpatient drugs, like those that you would get a prescription for and
pick up at the pharmacy. Medicare Part B only covers very limited
outpatient prescription drug benefits, like injections that need to be
given by a medical professional. For Medicare Part D, copays and
coinsurance vary by drug plan: $0–$5 for preferred generics, up to
50% for non-preferred drugs. For the unemployed that qualify for
Medicaid, outpatient prescription drugs are an optional benefit under
federal law, however, currently, all states provide drug coverage. For
children with private health insurance, the copay for prescriptions
lOMoARcPSD|61746433
depends on that specific insurance coverage. For low-income children,
the copay for medications is reduced if part of CHIP or possibly free if
on Medicaid. Vaccines are often free to uninsured and underinsured
children.
Referral to See a Specialist
In Japan, there is no 'gatekeeper'. Children, the unemployed, and the
retired do not need to get a referral to go see a specialist. The term
'general practice' in Japan is recent, but historically, there has been no
distinction between primary care and specialty care. The fee schedule
remains the same for all providers. Patients can see a specialist
without a referral and most of the time on a walk-in basis.
A 'gatekeeper' is very common for healthcare coverage in the United
States. American children, the unemployed, and the retired are often
limited to specialty services if it is not deemed necessary or they
cannot afford the excessive fees. PPO plans often can schedule an
appointment with a specialist without permission from their primary
care provider, but those with an HMO or government-sponsored plan
do not have that option. Outpatient specialists are free to choose which
form of insurance they will accept, or whether they will accept it at
all. For example, not all specialists accept publicly insured patients,
because of the relatively lower reimbursement rates set by Medicaid
and Medicare. Access to specialists for beneficiaries of these
programs—not to mention for people without any insurance—can
therefore be particularly limited.
Coverage for Preexisting Conditions
In Japan, no one can be excluded from any coverage based on a
preexisting condition. This also became true in the United States.
lOMoARcPSD|61746433
Under current law, health insurance companies can’t refuse to cover
you or charge you more just because you have a 'pre-existing
condition', that is, a health problem you had before the date that new
health coverage starts.
Finance Implications for Healthcare Delivery
In Japan, people benefit from the universal healthcare delivery system.
All fees are determined by the government and therefore controlled.
Even though most hospitals and medical offices are privately run, they
are limited on what they can charge based on government regulations.
This allows individuals to seek medical treatment and preventative
services more often, thus leading to better health. Not only is health
benefited but a person benefits financially as well. Unlike Americans,
the Japanese do not need to worry that paying for healthcare will lead
to financial ruin. A hospital stay is in the hundreds, whereas in the
United States, it is in the thousand and can leave a person bankrupt.
Americans often go without medical treatment simply based on the
fact that they cannot afford it. Especially if they do not have health
insurance, like in the circumstance of losing a job. In Japan, if a
person loses their job their health coverage just switches from the
employer to a community plan.
The negative financial implications of Japan’s healthcare structure fall
on the providers. 50% of hospitals are in financial deficit. This is the
opposite in America, where hospitals and doctors make a profit at the
expense of the people. In America private practices can, and often do,
refuse services to those with government-sponsored insurance like
Medicaid. This is mostly due to the low reimbursement and the length
of time to receive payment. This is not allowed in Japan. There are
lOMoARcPSD|61746433
also disincentives for providers prescribing certain medications or
services because the price is then lowered upon the next government
review of fees. Again, this benefits the consumer, not the provider.
In America, both public and private insurers determine their benefit
packages and cost-sharing structures as long as it is within federal and
state regulations. Private insurers in America are for-profit, while
Japan’s statutory health insurance system (SHIS) is a not-for-profit
system. Insurers in Japan are not out to make a profit. Anything
money not used is carried over to the next year, which could lead to
premiums being reduced.
Conclusion
In summary, the comparative analysis covered in this essay has shown
that the healthcare systems of Japan and America, although they share
some common features, are nevertheless different. As for me, I would
prefer the Japanese system, for its accessibility, simplicity, and
orientation for the benefit of its population.
The United States does not have a universal healthcare system. Health
care coverage in the United States is a mixture of public and private,
as well as for-profit and nonprofit insurers. Options include fee-for-
service (FFS), preferred provider organization (PPO), point of service
(POS), health maintenance organization (HMO), Medicare, Medicaid,
and coverage from the Veterans Health Administration. A majority of
US citizens have private insurance that is often provided through their
employer, or they may buy it on their own. 12.5% of US adults are
uninsured, and countless more are underinsured. Lack of health
insurance is perhaps the greatest barrier to accessing health care
lOMoARcPSD|61746433
services and has a tremendous negative effect on an individual’s
overall health status.
The only thing close to a universal healthcare system in the United
States is the Patient Protection and Affordable Care Act ( PPACA),
which was signed into law in 2010. Its goal was to expand health
insurance coverage to Americans that were uninsured while
controlling costs and improving the quality of healthcare. Since its
beginning, it has been under scrutiny, and many parts have been
amended, including removing the penalty fee for those that did not
have health insurance. With the implementation of the PPACA,
different plan options became available for people to obtain insurance,
but private insurance is the primary health coverage for two-thirds of
Americans (67%). Over half of all private insurance is through
employers. Most employer plans cover their employees and give
various options on the level of coverage and also the option to insure
their family. Rarely an employer pays the entire premium. Most of the
time the cost is shared between the employer and employee. Only
11% of private health insurance is purchased by individuals from for-
profit and nonprofit carriers.
In America, retirees/seniors qualify for Medicare. It is a complex fee-
for-service program consisting of parts, A-D. Part A provides hospital
insurance and Part B medical insurance. Members can choose to get
their coverage just through traditional Medicare, or they can choose to
enroll in Part C which is a private health maintenance organization
(HMO) called Medicare Advantage. Part D is also optional and is for
prescription drug coverage. Medicare is financed through a
lOMoARcPSD|61746433
combination of general federal taxes, a mandatory payroll tax that
pays for Part A, and individual premiums.
The unemployed may qualify for Medicaid if their income is low. It is
a jointly sponsored state and federal program that pays for medical
services for persons who are elderly, poor, blind, or disabled, and for
certain families with dependent children who meet specified income
guidelines. Medicaid is obtained through the state of residency. The
state then received federal matching for providing the health coverage.
Veterans can receive healthcare coverage from the Veterans Health
Administration. It is America’s largest integrated healthcare system
serving 9 million enrolled Veterans each year. Having other health
insurance coverage like Medicare, Medicaid, or private insurance
doesn’t affect getting VA healthcare benefits. Each veteran’s medical
benefits package is unique. Covered benefits depend on the 'priority
group' and the advice of the VA primary provider. Retiring veterans
may also be eligible for TRICARE. It is a Medicare-wraparound
coverage for those that have Medicare Part A and B.
There are two US government-run programs available to children
from low-income households. Depending on income level, they may
qualify for Medicaid or the Children’s Health Insurance Program
(CHIP). CHIP is a state-administered public program created in 1997
for children in low-income families that earn too much to qualify for
Medicaid but are unlikely to be able to afford private insurance. CHIP
is funded through matching grants from the federal government to the
states, and most states charge a low premium and have small copays,
if any. Because it is state-administered, exactly how it works varies by
state. For example, it is considered an extension of Medicaid in some
lOMoARcPSD|61746433
states, while in others it is a separate program. Currently, 9.6 million
children are covered by this program.
Coverage of Medications
In Japan, the coverage for medication for children, the unemployed,
and the retired remain under the same rules as the coinsurance
percentages. Clinics can dispense medication directly to the patients or
they can go to the pharmacy. According to the Commonwealth Fund,
the use of pharmacies has been growing. Price revisions for
medications are also revised every 2 years. Usually, prices are lowered
for new drugs that are selling more than expected, and for brand-name
drugs when their generic counterparts become available. Prices of
generic drugs have gradually decreased. Also, if a physician
prescribes more than 6 drugs regularly to a patient, he receives a
reduced fee as a way to improve clinical decision-making.
In the US, the coverage for medication for children, the unemployed,
the and retired depends on the coverage they have.
Retired individuals with Medicare have the option to purchase private
prescription drug coverage under Medicare Part D. Part D covers most
outpatient drugs, like those that you would get a prescription for and
pick up at the pharmacy. Medicare Part B only covers very limited
outpatient prescription drug benefits, like injections that need to be
given by a medical professional. For Medicare Part D, copays and
coinsurance vary by drug plan: $0–$5 for preferred generics, up to
50% for non-preferred drugs. For the unemployed that qualify for
Medicaid, outpatient prescription drugs are an optional benefit under
federal law, however, currently, all states provide drug coverage. For
children with private health insurance, the copay for prescriptions
lOMoARcPSD|61746433
depends on that specific insurance coverage. For low-income children,
the copay for medications is reduced if part of CHIP or possibly free if
on Medicaid. Vaccines are often free to uninsured and underinsured
children.
Referral to See a Specialist
In Japan, there is no 'gatekeeper'. Children, the unemployed, and the
retired do not need to get a referral to go see a specialist. The term
'general practice' in Japan is recent, but historically, there has been no
distinction between primary care and specialty care. The fee schedule
remains the same for all providers. Patients can see a specialist
without a referral and most of the time on a walk-in basis.
A 'gatekeeper' is very common for healthcare coverage in the United
States. American children, the unemployed, and the retired are often
limited to specialty services if it is not deemed necessary or they
cannot afford the excessive fees. PPO plans often can schedule an
appointment with a specialist without permission from their primary
care provider, but those with an HMO or government-sponsored plan
do not have that option. Outpatient specialists are free to choose which
form of insurance they will accept, or whether they will accept it at
all. For example, not all specialists accept publicly insured patients,
because of the relatively lower reimbursement rates set by Medicaid
and Medicare. Access to specialists for beneficiaries of these
programs—not to mention for people without any insurance—can
therefore be particularly limited.
Coverage for Preexisting Conditions
In Japan, no one can be excluded from any coverage based on a
preexisting condition. This also became true in the United States.
lOMoARcPSD|61746433
Under current law, health insurance companies can’t refuse to cover
you or charge you more just because you have a 'pre-existing
condition', that is, a health problem you had before the date that new
health coverage starts.
Finance Implications for Healthcare Delivery
In Japan, people benefit from the universal healthcare delivery system.
All fees are determined by the government and therefore controlled.
Even though most hospitals and medical offices are privately run, they
are limited on what they can charge based on government regulations.
This allows individuals to seek medical treatment and preventative
services more often, thus leading to better health. Not only is health
benefited but a person benefits financially as well. Unlike Americans,
the Japanese do not need to worry that paying for healthcare will lead
to financial ruin. A hospital stay is in the hundreds, whereas in the
United States, it is in the thousand and can leave a person bankrupt.
Americans often go without medical treatment simply based on the
fact that they cannot afford it. Especially if they do not have health
insurance, like in the circumstance of losing a job. In Japan, if a
person loses their job their health coverage just switches from the
employer to a community plan.
The negative financial implications of Japan’s healthcare structure fall
on the providers. 50% of hospitals are in financial deficit. This is the
opposite in America, where hospitals and doctors make a profit at the
expense of the people. In America private practices can, and often do,
refuse services to those with government-sponsored insurance like
Medicaid. This is mostly due to the low reimbursement and the length
of time to receive payment. This is not allowed in Japan. There are
lOMoARcPSD|61746433
also disincentives for providers prescribing certain medications or
services because the price is then lowered upon the next government
review of fees. Again, this benefits the consumer, not the provider.
In America, both public and private insurers determine their benefit
packages and cost-sharing structures as long as it is within federal and
state regulations. Private insurers in America are for-profit, while
Japan’s statutory health insurance system (SHIS) is a not-for-profit
system. Insurers in Japan are not out to make a profit. Anything
money not used is carried over to the next year, which could lead to
premiums being reduced.
Conclusion
In summary, the comparative analysis covered in this essay has shown
that the healthcare systems of Japan and America, although they share
some common features, are nevertheless different. As for me, I would
prefer the Japanese system, for its accessibility, simplicity, and
orientation for the benefit of its population.
The United States does not have a universal healthcare system. Health
care coverage in the United States is a mixture of public and private,
as well as for-profit and nonprofit insurers. Options include fee-for-
service (FFS), preferred provider organization (PPO), point of service
(POS), health maintenance organization (HMO), Medicare, Medicaid,
and coverage from the Veterans Health Administration. A majority of
US citizens have private insurance that is often provided through their
employer, or they may buy it on their own. 12.5% of US adults are
uninsured, and countless more are underinsured. Lack of health
insurance is perhaps the greatest barrier to accessing health care
lOMoARcPSD|61746433
services and has a tremendous negative effect on an individual’s
overall health status.
The only thing close to a universal healthcare system in the United
States is the Patient Protection and Affordable Care Act ( PPACA),
which was signed into law in 2010. Its goal was to expand health
insurance coverage to Americans that were uninsured while
controlling costs and improving the quality of healthcare. Since its
beginning, it has been under scrutiny, and many parts have been
amended, including removing the penalty fee for those that did not
have health insurance. With the implementation of the PPACA,
different plan options became available for people to obtain insurance,
but private insurance is the primary health coverage for two-thirds of
Americans (67%). Over half of all private insurance is through
employers. Most employer plans cover their employees and give
various options on the level of coverage and also the option to insure
their family. Rarely an employer pays the entire premium. Most of the
time the cost is shared between the employer and employee. Only
11% of private health insurance is purchased by individuals from for-
profit and nonprofit carriers.
In America, retirees/seniors qualify for Medicare. It is a complex fee-
for-service program consisting of parts, A-D. Part A provides hospital
insurance and Part B medical insurance. Members can choose to get
their coverage just through traditional Medicare, or they can choose to
enroll in Part C which is a private health maintenance organization
(HMO) called Medicare Advantage. Part D is also optional and is for
prescription drug coverage. Medicare is financed through a
lOMoARcPSD|61746433
combination of general federal taxes, a mandatory payroll tax that
pays for Part A, and individual premiums.
The unemployed may qualify for Medicaid if their income is low. It is
a jointly sponsored state and federal program that pays for medical
services for persons who are elderly, poor, blind, or disabled, and for
certain families with dependent children who meet specified income
guidelines. Medicaid is obtained through the state of residency. The
state then received federal matching for providing the health coverage.
Veterans can receive healthcare coverage from the Veterans Health
Administration. It is America’s largest integrated healthcare system
serving 9 million enrolled Veterans each year. Having other health
insurance coverage like Medicare, Medicaid, or private insurance
doesn’t affect getting VA healthcare benefits. Each veteran’s medical
benefits package is unique. Covered benefits depend on the 'priority
group' and the advice of the VA primary provider. Retiring veterans
may also be eligible for TRICARE. It is a Medicare-wraparound
coverage for those that have Medicare Part A and B.
There are two US government-run programs available to children
from low-income households. Depending on income level, they may
qualify for Medicaid or the Children’s Health Insurance Program
(CHIP). CHIP is a state-administered public program created in 1997
for children in low-income families that earn too much to qualify for
Medicaid but are unlikely to be able to afford private insurance. CHIP
is funded through matching grants from the federal government to the
states, and most states charge a low premium and have small copays,
if any. Because it is state-administered, exactly how it works varies by
state. For example, it is considered an extension of Medicaid in some
lOMoARcPSD|61746433
states, while in others it is a separate program. Currently, 9.6 million
children are covered by this program.
Coverage of Medications
In Japan, the coverage for medication for children, the unemployed,
and the retired remain under the same rules as the coinsurance
percentages. Clinics can dispense medication directly to the patients or
they can go to the pharmacy. According to the Commonwealth Fund,
the use of pharmacies has been growing. Price revisions for
medications are also revised every 2 years. Usually, prices are lowered
for new drugs that are selling more than expected, and for brand-name
drugs when their generic counterparts become available. Prices of
generic drugs have gradually decreased. Also, if a physician
prescribes more than 6 drugs regularly to a patient, he receives a
reduced fee as a way to improve clinical decision-making.
In the US, the coverage for medication for children, the unemployed,
the and retired depends on the coverage they have.
Retired individuals with Medicare have the option to purchase private
prescription drug coverage under Medicare Part D. Part D covers most
outpatient drugs, like those that you would get a prescription for and
pick up at the pharmacy. Medicare Part B only covers very limited
outpatient prescription drug benefits, like injections that need to be
given by a medical professional. For Medicare Part D, copays and
coinsurance vary by drug plan: $0–$5 for preferred generics, up to
50% for non-preferred drugs. For the unemployed that qualify for
Medicaid, outpatient prescription drugs are an optional benefit under
federal law, however, currently, all states provide drug coverage. For
children with private health insurance, the copay for prescriptions
lOMoARcPSD|61746433
depends on that specific insurance coverage. For low-income children,
the copay for medications is reduced if part of CHIP or possibly free if
on Medicaid. Vaccines are often free to uninsured and underinsured
children.
Referral to See a Specialist
In Japan, there is no 'gatekeeper'. Children, the unemployed, and the
retired do not need to get a referral to go see a specialist. The term
'general practice' in Japan is recent, but historically, there has been no
distinction between primary care and specialty care. The fee schedule
remains the same for all providers. Patients can see a specialist
without a referral and most of the time on a walk-in basis.
A 'gatekeeper' is very common for healthcare coverage in the United
States. American children, the unemployed, and the retired are often
limited to specialty services if it is not deemed necessary or they
cannot afford the excessive fees. PPO plans often can schedule an
appointment with a specialist without permission from their primary
care provider, but those with an HMO or government-sponsored plan
do not have that option. Outpatient specialists are free to choose which
form of insurance they will accept, or whether they will accept it at
all. For example, not all specialists accept publicly insured patients,
because of the relatively lower reimbursement rates set by Medicaid
and Medicare. Access to specialists for beneficiaries of these
programs—not to mention for people without any insurance—can
therefore be particularly limited.
Coverage for Preexisting Conditions
In Japan, no one can be excluded from any coverage based on a
preexisting condition. This also became true in the United States.
lOMoARcPSD|61746433
Under current law, health insurance companies can’t refuse to cover
you or charge you more just because you have a 'pre-existing
condition', that is, a health problem you had before the date that new
health coverage starts.
Finance Implications for Healthcare Delivery
In Japan, people benefit from the universal healthcare delivery system.
All fees are determined by the government and therefore controlled.
Even though most hospitals and medical offices are privately run, they
are limited on what they can charge based on government regulations.
This allows individuals to seek medical treatment and preventative
services more often, thus leading to better health. Not only is health
benefited but a person benefits financially as well. Unlike Americans,
the Japanese do not need to worry that paying for healthcare will lead
to financial ruin. A hospital stay is in the hundreds, whereas in the
United States, it is in the thousand and can leave a person bankrupt.
Americans often go without medical treatment simply based on the
fact that they cannot afford it. Especially if they do not have health
insurance, like in the circumstance of losing a job. In Japan, if a
person loses their job their health coverage just switches from the
employer to a community plan.
The negative financial implications of Japan’s healthcare structure fall
on the providers. 50% of hospitals are in financial deficit. This is the
opposite in America, where hospitals and doctors make a profit at the
expense of the people. In America private practices can, and often do,
refuse services to those with government-sponsored insurance like
Medicaid. This is mostly due to the low reimbursement and the length
of time to receive payment. This is not allowed in Japan. There are
lOMoARcPSD|61746433
also disincentives for providers prescribing certain medications or
services because the price is then lowered upon the next government
review of fees. Again, this benefits the consumer, not the provider.
In America, both public and private insurers determine their benefit
packages and cost-sharing structures as long as it is within federal and
state regulations. Private insurers in America are for-profit, while
Japan’s statutory health insurance system (SHIS) is a not-for-profit
system. Insurers in Japan are not out to make a profit. Anything
money not used is carried over to the next year, which could lead to
premiums being reduced.
Conclusion
In summary, the comparative analysis covered in this essay has shown
that the healthcare systems of Japan and America, although they share
some common features, are nevertheless different. As for me, I would
prefer the Japanese system, for its accessibility, simplicity, and
orientation for the benefit of its population.
The United States does not have a universal healthcare system. Health
care coverage in the United States is a mixture of public and private,
as well as for-profit and nonprofit insurers. Options include fee-for-
service (FFS), preferred provider organization (PPO), point of service
(POS), health maintenance organization (HMO), Medicare, Medicaid,
and coverage from the Veterans Health Administration. A majority of
US citizens have private insurance that is often provided through their
employer, or they may buy it on their own. 12.5% of US adults are
uninsured, and countless more are underinsured. Lack of health
insurance is perhaps the greatest barrier to accessing health care
lOMoARcPSD|61746433
services and has a tremendous negative effect on an individual’s
overall health status.
The only thing close to a universal healthcare system in the United
States is the Patient Protection and Affordable Care Act ( PPACA),
which was signed into law in 2010. Its goal was to expand health
insurance coverage to Americans that were uninsured while
controlling costs and improving the quality of healthcare. Since its
beginning, it has been under scrutiny, and many parts have been
amended, including removing the penalty fee for those that did not
have health insurance. With the implementation of the PPACA,
different plan options became available for people to obtain insurance,
but private insurance is the primary health coverage for two-thirds of
Americans (67%). Over half of all private insurance is through
employers. Most employer plans cover their employees and give
various options on the level of coverage and also the option to insure
their family. Rarely an employer pays the entire premium. Most of the
time the cost is shared between the employer and employee. Only
11% of private health insurance is purchased by individuals from for-
profit and nonprofit carriers.
In America, retirees/seniors qualify for Medicare. It is a complex fee-
for-service program consisting of parts, A-D. Part A provides hospital
insurance and Part B medical insurance. Members can choose to get
their coverage just through traditional Medicare, or they can choose to
enroll in Part C which is a private health maintenance organization
(HMO) called Medicare Advantage. Part D is also optional and is for
prescription drug coverage. Medicare is financed through a
lOMoARcPSD|61746433
combination of general federal taxes, a mandatory payroll tax that
pays for Part A, and individual premiums.
The unemployed may qualify for Medicaid if their income is low. It is
a jointly sponsored state and federal program that pays for medical
services for persons who are elderly, poor, blind, or disabled, and for
certain families with dependent children who meet specified income
guidelines. Medicaid is obtained through the state of residency. The
state then received federal matching for providing the health coverage.
Veterans can receive healthcare coverage from the Veterans Health
Administration. It is America’s largest integrated healthcare system
serving 9 million enrolled Veterans each year. Having other health
insurance coverage like Medicare, Medicaid, or private insurance
doesn’t affect getting VA healthcare benefits. Each veteran’s medical
benefits package is unique. Covered benefits depend on the 'priority
group' and the advice of the VA primary provider. Retiring veterans
may also be eligible for TRICARE. It is a Medicare-wraparound
coverage for those that have Medicare Part A and B.
There are two US government-run programs available to children
from low-income households. Depending on income level, they may
qualify for Medicaid or the Children’s Health Insurance Program
(CHIP). CHIP is a state-administered public program created in 1997
for children in low-income families that earn too much to qualify for
Medicaid but are unlikely to be able to afford private insurance. CHIP
is funded through matching grants from the federal government to the
states, and most states charge a low premium and have small copays,
if any. Because it is state-administered, exactly how it works varies by
state. For example, it is considered an extension of Medicaid in some
lOMoARcPSD|61746433
states, while in others it is a separate program. Currently, 9.6 million
children are covered by this program.
Coverage of Medications
In Japan, the coverage for medication for children, the unemployed,
and the retired remain under the same rules as the coinsurance
percentages. Clinics can dispense medication directly to the patients or
they can go to the pharmacy. According to the Commonwealth Fund,
the use of pharmacies has been growing. Price revisions for
medications are also revised every 2 years. Usually, prices are lowered
for new drugs that are selling more than expected, and for brand-name
drugs when their generic counterparts become available. Prices of
generic drugs have gradually decreased. Also, if a physician
prescribes more than 6 drugs regularly to a patient, he receives a
reduced fee as a way to improve clinical decision-making.
In the US, the coverage for medication for children, the unemployed,
the and retired depends on the coverage they have.
Retired individuals with Medicare have the option to purchase private
prescription drug coverage under Medicare Part D. Part D covers most
outpatient drugs, like those that you would get a prescription for and
pick up at the pharmacy. Medicare Part B only covers very limited
outpatient prescription drug benefits, like injections that need to be
given by a medical professional. For Medicare Part D, copays and
coinsurance vary by drug plan: $0–$5 for preferred generics, up to
50% for non-preferred drugs. For the unemployed that qualify for
Medicaid, outpatient prescription drugs are an optional benefit under
federal law, however, currently, all states provide drug coverage. For
children with private health insurance, the copay for prescriptions
lOMoARcPSD|61746433
depends on that specific insurance coverage. For low-income children,
the copay for medications is reduced if part of CHIP or possibly free if
on Medicaid. Vaccines are often free to uninsured and underinsured
children.
Referral to See a Specialist
In Japan, there is no 'gatekeeper'. Children, the unemployed, and the
retired do not need to get a referral to go see a specialist. The term
'general practice' in Japan is recent, but historically, there has been no
distinction between primary care and specialty care. The fee schedule
remains the same for all providers. Patients can see a specialist
without a referral and most of the time on a walk-in basis.
A 'gatekeeper' is very common for healthcare coverage in the United
States. American children, the unemployed, and the retired are often
limited to specialty services if it is not deemed necessary or they
cannot afford the excessive fees. PPO plans often can schedule an
appointment with a specialist without permission from their primary
care provider, but those with an HMO or government-sponsored plan
do not have that option. Outpatient specialists are free to choose which
form of insurance they will accept, or whether they will accept it at
all. For example, not all specialists accept publicly insured patients,
because of the relatively lower reimbursement rates set by Medicaid
and Medicare. Access to specialists for beneficiaries of these
programs—not to mention for people without any insurance—can
therefore be particularly limited.
Coverage for Preexisting Conditions
In Japan, no one can be excluded from any coverage based on a
preexisting condition. This also became true in the United States.
lOMoARcPSD|61746433
Under current law, health insurance companies can’t refuse to cover
you or charge you more just because you have a 'pre-existing
condition', that is, a health problem you had before the date that new
health coverage starts.
Finance Implications for Healthcare Delivery
In Japan, people benefit from the universal healthcare delivery system.
All fees are determined by the government and therefore controlled.
Even though most hospitals and medical offices are privately run, they
are limited on what they can charge based on government regulations.
This allows individuals to seek medical treatment and preventative
services more often, thus leading to better health. Not only is health
benefited but a person benefits financially as well. Unlike Americans,
the Japanese do not need to worry that paying for healthcare will lead
to financial ruin. A hospital stay is in the hundreds, whereas in the
United States, it is in the thousand and can leave a person bankrupt.
Americans often go without medical treatment simply based on the
fact that they cannot afford it. Especially if they do not have health
insurance, like in the circumstance of losing a job. In Japan, if a
person loses their job their health coverage just switches from the
employer to a community plan.
The negative financial implications of Japan’s healthcare structure fall
on the providers. 50% of hospitals are in financial deficit. This is the
opposite in America, where hospitals and doctors make a profit at the
expense of the people. In America private practices can, and often do,
refuse services to those with government-sponsored insurance like
Medicaid. This is mostly due to the low reimbursement and the length
of time to receive payment. This is not allowed in Japan. There are
lOMoARcPSD|61746433
also disincentives for providers prescribing certain medications or
services because the price is then lowered upon the next government
review of fees. Again, this benefits the consumer, not the provider.
In America, both public and private insurers determine their benefit
packages and cost-sharing structures as long as it is within federal and
state regulations. Private insurers in America are for-profit, while
Japan’s statutory health insurance system (SHIS) is a not-for-profit
system. Insurers in Japan are not out to make a profit. Anything
money not used is carried over to the next year, which could lead to
premiums being reduced.
Conclusion
In summary, the comparative analysis covered in this essay has shown
that the healthcare systems of Japan and America, although they share
some common features, are nevertheless different. As for me, I would
prefer the Japanese system, for its accessibility, simplicity, and
orientation for the benefit of its population.
The United States does not have a universal healthcare system. Health
care coverage in the United States is a mixture of public and private,
as well as for-profit and nonprofit insurers. Options include fee-for-
service (FFS), preferred provider organization (PPO), point of service
(POS), health maintenance organization (HMO), Medicare, Medicaid,
and coverage from the Veterans Health Administration. A majority of
US citizens have private insurance that is often provided through their
employer, or they may buy it on their own. 12.5% of US adults are
uninsured, and countless more are underinsured. Lack of health
insurance is perhaps the greatest barrier to accessing health care
lOMoARcPSD|61746433
services and has a tremendous negative effect on an individual’s
overall health status.
The only thing close to a universal healthcare system in the United
States is the Patient Protection and Affordable Care Act ( PPACA),
which was signed into law in 2010. Its goal was to expand health
insurance coverage to Americans that were uninsured while
controlling costs and improving the quality of healthcare. Since its
beginning, it has been under scrutiny, and many parts have been
amended, including removing the penalty fee for those that did not
have health insurance. With the implementation of the PPACA,
different plan options became available for people to obtain insurance,
but private insurance is the primary health coverage for two-thirds of
Americans (67%). Over half of all private insurance is through
employers. Most employer plans cover their employees and give
various options on the level of coverage and also the option to insure
their family. Rarely an employer pays the entire premium. Most of the
time the cost is shared between the employer and employee. Only
11% of private health insurance is purchased by individuals from for-
profit and nonprofit carriers.
In America, retirees/seniors qualify for Medicare. It is a complex fee-
for-service program consisting of parts, A-D. Part A provides hospital
insurance and Part B medical insurance. Members can choose to get
their coverage just through traditional Medicare, or they can choose to
enroll in Part C which is a private health maintenance organization
(HMO) called Medicare Advantage. Part D is also optional and is for
prescription drug coverage. Medicare is financed through a
lOMoARcPSD|61746433
combination of general federal taxes, a mandatory payroll tax that
pays for Part A, and individual premiums.
The unemployed may qualify for Medicaid if their income is low. It is
a jointly sponsored state and federal program that pays for medical
services for persons who are elderly, poor, blind, or disabled, and for
certain families with dependent children who meet specified income
guidelines. Medicaid is obtained through the state of residency. The
state then received federal matching for providing the health coverage.
Veterans can receive healthcare coverage from the Veterans Health
Administration. It is America’s largest integrated healthcare system
serving 9 million enrolled Veterans each year. Having other health
insurance coverage like Medicare, Medicaid, or private insurance
doesn’t affect getting VA healthcare benefits. Each veteran’s medical
benefits package is unique. Covered benefits depend on the 'priority
group' and the advice of the VA primary provider. Retiring veterans
may also be eligible for TRICARE. It is a Medicare-wraparound
coverage for those that have Medicare Part A and B.
There are two US government-run programs available to children
from low-income households. Depending on income level, they may
qualify for Medicaid or the Children’s Health Insurance Program
(CHIP). CHIP is a state-administered public program created in 1997
for children in low-income families that earn too much to qualify for
Medicaid but are unlikely to be able to afford private insurance. CHIP
is funded through matching grants from the federal government to the
states, and most states charge a low premium and have small copays,
if any. Because it is state-administered, exactly how it works varies by
state. For example, it is considered an extension of Medicaid in some
lOMoARcPSD|61746433
states, while in others it is a separate program. Currently, 9.6 million
children are covered by this program.
Coverage of Medications
In Japan, the coverage for medication for children, the unemployed,
and the retired remain under the same rules as the coinsurance
percentages. Clinics can dispense medication directly to the patients or
they can go to the pharmacy. According to the Commonwealth Fund,
the use of pharmacies has been growing. Price revisions for
medications are also revised every 2 years. Usually, prices are lowered
for new drugs that are selling more than expected, and for brand-name
drugs when their generic counterparts become available. Prices of
generic drugs have gradually decreased. Also, if a physician
prescribes more than 6 drugs regularly to a patient, he receives a
reduced fee as a way to improve clinical decision-making.
In the US, the coverage for medication for children, the unemployed,
the and retired depends on the coverage they have.
Retired individuals with Medicare have the option to purchase private
prescription drug coverage under Medicare Part D. Part D covers most
outpatient drugs, like those that you would get a prescription for and
pick up at the pharmacy. Medicare Part B only covers very limited
outpatient prescription drug benefits, like injections that need to be
given by a medical professional. For Medicare Part D, copays and
coinsurance vary by drug plan: $0–$5 for preferred generics, up to
50% for non-preferred drugs. For the unemployed that qualify for
Medicaid, outpatient prescription drugs are an optional benefit under
federal law, however, currently, all states provide drug coverage. For
children with private health insurance, the copay for prescriptions
lOMoARcPSD|61746433
depends on that specific insurance coverage. For low-income children,
the copay for medications is reduced if part of CHIP or possibly free if
on Medicaid. Vaccines are often free to uninsured and underinsured
children.
Referral to See a Specialist
In Japan, there is no 'gatekeeper'. Children, the unemployed, and the
retired do not need to get a referral to go see a specialist. The term
'general practice' in Japan is recent, but historically, there has been no
distinction between primary care and specialty care. The fee schedule
remains the same for all providers. Patients can see a specialist
without a referral and most of the time on a walk-in basis.
A 'gatekeeper' is very common for healthcare coverage in the United
States. American children, the unemployed, and the retired are often
limited to specialty services if it is not deemed necessary or they
cannot afford the excessive fees. PPO plans often can schedule an
appointment with a specialist without permission from their primary
care provider, but those with an HMO or government-sponsored plan
do not have that option. Outpatient specialists are free to choose which
form of insurance they will accept, or whether they will accept it at
all. For example, not all specialists accept publicly insured patients,
because of the relatively lower reimbursement rates set by Medicaid
and Medicare. Access to specialists for beneficiaries of these
programs—not to mention for people without any insurance—can
therefore be particularly limited.
Coverage for Preexisting Conditions
In Japan, no one can be excluded from any coverage based on a
preexisting condition. This also became true in the United States.
lOMoARcPSD|61746433
Under current law, health insurance companies can’t refuse to cover
you or charge you more just because you have a 'pre-existing
condition', that is, a health problem you had before the date that new
health coverage starts.
Finance Implications for Healthcare Delivery
In Japan, people benefit from the universal healthcare delivery system.
All fees are determined by the government and therefore controlled.
Even though most hospitals and medical offices are privately run, they
are limited on what they can charge based on government regulations.
This allows individuals to seek medical treatment and preventative
services more often, thus leading to better health. Not only is health
benefited but a person benefits financially as well. Unlike Americans,
the Japanese do not need to worry that paying for healthcare will lead
to financial ruin. A hospital stay is in the hundreds, whereas in the
United States, it is in the thousand and can leave a person bankrupt.
Americans often go without medical treatment simply based on the
fact that they cannot afford it. Especially if they do not have health
insurance, like in the circumstance of losing a job. In Japan, if a
person loses their job their health coverage just switches from the
employer to a community plan.
The negative financial implications of Japan’s healthcare structure fall
on the providers. 50% of hospitals are in financial deficit. This is the
opposite in America, where hospitals and doctors make a profit at the
expense of the people. In America private practices can, and often do,
refuse services to those with government-sponsored insurance like
Medicaid. This is mostly due to the low reimbursement and the length
of time to receive payment. This is not allowed in Japan. There are
lOMoARcPSD|61746433
also disincentives for providers prescribing certain medications or
services because the price is then lowered upon the next government
review of fees. Again, this benefits the consumer, not the provider.
In America, both public and private insurers determine their benefit
packages and cost-sharing structures as long as it is within federal and
state regulations. Private insurers in America are for-profit, while
Japan’s statutory health insurance system (SHIS) is a not-for-profit
system. Insurers in Japan are not out to make a profit. Anything
money not used is carried over to the next year, which could lead to
premiums being reduced.
Conclusion
In summary, the comparative analysis covered in this essay has shown
that the healthcare systems of Japan and America, although they share
some common features, are nevertheless different. As for me, I would
prefer the Japanese system, for its accessibility, simplicity, and
orientation for the benefit of its population.
The United States does not have a universal healthcare system. Health
care coverage in the United States is a mixture of public and private,
as well as for-profit and nonprofit insurers. Options include fee-for-
service (FFS), preferred provider organization (PPO), point of service
(POS), health maintenance organization (HMO), Medicare, Medicaid,
and coverage from the Veterans Health Administration. A majority of
US citizens have private insurance that is often provided through their
employer, or they may buy it on their own. 12.5% of US adults are
uninsured, and countless more are underinsured. Lack of health
insurance is perhaps the greatest barrier to accessing health care
lOMoARcPSD|61746433
services and has a tremendous negative effect on an individual’s
overall health status.
The only thing close to a universal healthcare system in the United
States is the Patient Protection and Affordable Care Act ( PPACA),
which was signed into law in 2010. Its goal was to expand health
insurance coverage to Americans that were uninsured while
controlling costs and improving the quality of healthcare. Since its
beginning, it has been under scrutiny, and many parts have been
amended, including removing the penalty fee for those that did not
have health insurance. With the implementation of the PPACA,
different plan options became available for people to obtain insurance,
but private insurance is the primary health coverage for two-thirds of
Americans (67%). Over half of all private insurance is through
employers. Most employer plans cover their employees and give
various options on the level of coverage and also the option to insure
their family. Rarely an employer pays the entire premium. Most of the
time the cost is shared between the employer and employee. Only
11% of private health insurance is purchased by individuals from for-
profit and nonprofit carriers.
In America, retirees/seniors qualify for Medicare. It is a complex fee-
for-service program consisting of parts, A-D. Part A provides hospital
insurance and Part B medical insurance. Members can choose to get
their coverage just through traditional Medicare, or they can choose to
enroll in Part C which is a private health maintenance organization
(HMO) called Medicare Advantage. Part D is also optional and is for
prescription drug coverage. Medicare is financed through a
lOMoARcPSD|61746433
combination of general federal taxes, a mandatory payroll tax that
pays for Part A, and individual premiums.
The unemployed may qualify for Medicaid if their income is low. It is
a jointly sponsored state and federal program that pays for medical
services for persons who are elderly, poor, blind, or disabled, and for
certain families with dependent children who meet specified income
guidelines. Medicaid is obtained through the state of residency. The
state then received federal matching for providing the health coverage.
Veterans can receive healthcare coverage from the Veterans Health
Administration. It is America’s largest integrated healthcare system
serving 9 million enrolled Veterans each year. Having other health
insurance coverage like Medicare, Medicaid, or private insurance
doesn’t affect getting VA healthcare benefits. Each veteran’s medical
benefits package is unique. Covered benefits depend on the 'priority
group' and the advice of the VA primary provider. Retiring veterans
may also be eligible for TRICARE. It is a Medicare-wraparound
coverage for those that have Medicare Part A and B.
There are two US government-run programs available to children
from low-income households. Depending on income level, they may
qualify for Medicaid or the Children’s Health Insurance Program
(CHIP). CHIP is a state-administered public program created in 1997
for children in low-income families that earn too much to qualify for
Medicaid but are unlikely to be able to afford private insurance. CHIP
is funded through matching grants from the federal government to the
states, and most states charge a low premium and have small copays,
if any. Because it is state-administered, exactly how it works varies by
state. For example, it is considered an extension of Medicaid in some
lOMoARcPSD|61746433
states, while in others it is a separate program. Currently, 9.6 million
children are covered by this program.
Coverage of Medications
In Japan, the coverage for medication for children, the unemployed,
and the retired remain under the same rules as the coinsurance
percentages. Clinics can dispense medication directly to the patients or
they can go to the pharmacy. According to the Commonwealth Fund,
the use of pharmacies has been growing. Price revisions for
medications are also revised every 2 years. Usually, prices are lowered
for new drugs that are selling more than expected, and for brand-name
drugs when their generic counterparts become available. Prices of
generic drugs have gradually decreased. Also, if a physician
prescribes more than 6 drugs regularly to a patient, he receives a
reduced fee as a way to improve clinical decision-making.
In the US, the coverage for medication for children, the unemployed,
the and retired depends on the coverage they have.
Retired individuals with Medicare have the option to purchase private
prescription drug coverage under Medicare Part D. Part D covers most
outpatient drugs, like those that you would get a prescription for and
pick up at the pharmacy. Medicare Part B only covers very limited
outpatient prescription drug benefits, like injections that need to be
given by a medical professional. For Medicare Part D, copays and
coinsurance vary by drug plan: $0–$5 for preferred generics, up to
50% for non-preferred drugs. For the unemployed that qualify for
Medicaid, outpatient prescription drugs are an optional benefit under
federal law, however, currently, all states provide drug coverage. For
children with private health insurance, the copay for prescriptions
lOMoARcPSD|61746433
depends on that specific insurance coverage. For low-income children,
the copay for medications is reduced if part of CHIP or possibly free if
on Medicaid. Vaccines are often free to uninsured and underinsured
children.
Referral to See a Specialist
In Japan, there is no 'gatekeeper'. Children, the unemployed, and the
retired do not need to get a referral to go see a specialist. The term
'general practice' in Japan is recent, but historically, there has been no
distinction between primary care and specialty care. The fee schedule
remains the same for all providers. Patients can see a specialist
without a referral and most of the time on a walk-in basis.
A 'gatekeeper' is very common for healthcare coverage in the United
States. American children, the unemployed, and the retired are often
limited to specialty services if it is not deemed necessary or they
cannot afford the excessive fees. PPO plans often can schedule an
appointment with a specialist without permission from their primary
care provider, but those with an HMO or government-sponsored plan
do not have that option. Outpatient specialists are free to choose which
form of insurance they will accept, or whether they will accept it at
all. For example, not all specialists accept publicly insured patients,
because of the relatively lower reimbursement rates set by Medicaid
and Medicare. Access to specialists for beneficiaries of these
programs—not to mention for people without any insurance—can
therefore be particularly limited.
Coverage for Preexisting Conditions
In Japan, no one can be excluded from any coverage based on a
preexisting condition. This also became true in the United States.
lOMoARcPSD|61746433
Under current law, health insurance companies can’t refuse to cover
you or charge you more just because you have a 'pre-existing
condition', that is, a health problem you had before the date that new
health coverage starts.
Finance Implications for Healthcare Delivery
In Japan, people benefit from the universal healthcare delivery system.
All fees are determined by the government and therefore controlled.
Even though most hospitals and medical offices are privately run, they
are limited on what they can charge based on government regulations.
This allows individuals to seek medical treatment and preventative
services more often, thus leading to better health. Not only is health
benefited but a person benefits financially as well. Unlike Americans,
the Japanese do not need to worry that paying for healthcare will lead
to financial ruin. A hospital stay is in the hundreds, whereas in the
United States, it is in the thousand and can leave a person bankrupt.
Americans often go without medical treatment simply based on the
fact that they cannot afford it. Especially if they do not have health
insurance, like in the circumstance of losing a job. In Japan, if a
person loses their job their health coverage just switches from the
employer to a community plan.
The negative financial implications of Japan’s healthcare structure fall
on the providers. 50% of hospitals are in financial deficit. This is the
opposite in America, where hospitals and doctors make a profit at the
expense of the people. In America private practices can, and often do,
refuse services to those with government-sponsored insurance like
Medicaid. This is mostly due to the low reimbursement and the length
of time to receive payment. This is not allowed in Japan. There are
lOMoARcPSD|61746433
also disincentives for providers prescribing certain medications or
services because the price is then lowered upon the next government
review of fees. Again, this benefits the consumer, not the provider.
In America, both public and private insurers determine their benefit
packages and cost-sharing structures as long as it is within federal and
state regulations. Private insurers in America are for-profit, while
Japan’s statutory health insurance system (SHIS) is a not-for-profit
system. Insurers in Japan are not out to make a profit. Anything
money not used is carried over to the next year, which could lead to
premiums being reduced.
Conclusion
In summary, the comparative analysis covered in this essay has shown
that the healthcare systems of Japan and America, although they share
some common features, are nevertheless different. As for me, I would
prefer the Japanese system, for its accessibility, simplicity, and
orientation for the benefit of its population.
The United States does not have a universal healthcare system. Health
care coverage in the United States is a mixture of public and private,
as well as for-profit and nonprofit insurers. Options include fee-for-
service (FFS), preferred provider organization (PPO), point of service
(POS), health maintenance organization (HMO), Medicare, Medicaid,
and coverage from the Veterans Health Administration. A majority of
US citizens have private insurance that is often provided through their
employer, or they may buy it on their own. 12.5% of US adults are
uninsured, and countless more are underinsured. Lack of health
insurance is perhaps the greatest barrier to accessing health care
lOMoARcPSD|61746433
services and has a tremendous negative effect on an individual’s
overall health status.
The only thing close to a universal healthcare system in the United
States is the Patient Protection and Affordable Care Act ( PPACA),
which was signed into law in 2010. Its goal was to expand health
insurance coverage to Americans that were uninsured while
controlling costs and improving the quality of healthcare. Since its
beginning, it has been under scrutiny, and many parts have been
amended, including removing the penalty fee for those that did not
have health insurance. With the implementation of the PPACA,
different plan options became available for people to obtain insurance,
but private insurance is the primary health coverage for two-thirds of
Americans (67%). Over half of all private insurance is through
employers. Most employer plans cover their employees and give
various options on the level of coverage and also the option to insure
their family. Rarely an employer pays the entire premium. Most of the
time the cost is shared between the employer and employee. Only
11% of private health insurance is purchased by individuals from for-
profit and nonprofit carriers.
In America, retirees/seniors qualify for Medicare. It is a complex fee-
for-service program consisting of parts, A-D. Part A provides hospital
insurance and Part B medical insurance. Members can choose to get
their coverage just through traditional Medicare, or they can choose to
enroll in Part C which is a private health maintenance organization
(HMO) called Medicare Advantage. Part D is also optional and is for
prescription drug coverage. Medicare is financed through a
lOMoARcPSD|61746433
combination of general federal taxes, a mandatory payroll tax that
pays for Part A, and individual premiums.
The unemployed may qualify for Medicaid if their income is low. It is
a jointly sponsored state and federal program that pays for medical
services for persons who are elderly, poor, blind, or disabled, and for
certain families with dependent children who meet specified income
guidelines. Medicaid is obtained through the state of residency. The
state then received federal matching for providing the health coverage.
Veterans can receive healthcare coverage from the Veterans Health
Administration. It is America’s largest integrated healthcare system
serving 9 million enrolled Veterans each year. Having other health
insurance coverage like Medicare, Medicaid, or private insurance
doesn’t affect getting VA healthcare benefits. Each veteran’s medical
benefits package is unique. Covered benefits depend on the 'priority
group' and the advice of the VA primary provider. Retiring veterans
may also be eligible for TRICARE. It is a Medicare-wraparound
coverage for those that have Medicare Part A and B.
There are two US government-run programs available to children
from low-income households. Depending on income level, they may
qualify for Medicaid or the Children’s Health Insurance Program
(CHIP). CHIP is a state-administered public program created in 1997
for children in low-income families that earn too much to qualify for
Medicaid but are unlikely to be able to afford private insurance. CHIP
is funded through matching grants from the federal government to the
states, and most states charge a low premium and have small copays,
if any. Because it is state-administered, exactly how it works varies by
state. For example, it is considered an extension of Medicaid in some
lOMoARcPSD|61746433
states, while in others it is a separate program. Currently, 9.6 million
children are covered by this program.
Coverage of Medications
In Japan, the coverage for medication for children, the unemployed,
and the retired remain under the same rules as the coinsurance
percentages. Clinics can dispense medication directly to the patients or
they can go to the pharmacy. According to the Commonwealth Fund,
the use of pharmacies has been growing. Price revisions for
medications are also revised every 2 years. Usually, prices are lowered
for new drugs that are selling more than expected, and for brand-name
drugs when their generic counterparts become available. Prices of
generic drugs have gradually decreased. Also, if a physician
prescribes more than 6 drugs regularly to a patient, he receives a
reduced fee as a way to improve clinical decision-making.
In the US, the coverage for medication for children, the unemployed,
the and retired depends on the coverage they have.
Retired individuals with Medicare have the option to purchase private
prescription drug coverage under Medicare Part D. Part D covers most
outpatient drugs, like those that you would get a prescription for and
pick up at the pharmacy. Medicare Part B only covers very limited
outpatient prescription drug benefits, like injections that need to be
given by a medical professional. For Medicare Part D, copays and
coinsurance vary by drug plan: $0–$5 for preferred generics, up to
50% for non-preferred drugs. For the unemployed that qualify for
Medicaid, outpatient prescription drugs are an optional benefit under
federal law, however, currently, all states provide drug coverage. For
children with private health insurance, the copay for prescriptions
lOMoARcPSD|61746433
depends on that specific insurance coverage. For low-income children,
the copay for medications is reduced if part of CHIP or possibly free if
on Medicaid. Vaccines are often free to uninsured and underinsured
children.
Referral to See a Specialist
In Japan, there is no 'gatekeeper'. Children, the unemployed, and the
retired do not need to get a referral to go see a specialist. The term
'general practice' in Japan is recent, but historically, there has been no
distinction between primary care and specialty care. The fee schedule
remains the same for all providers. Patients can see a specialist
without a referral and most of the time on a walk-in basis.
A 'gatekeeper' is very common for healthcare coverage in the United
States. American children, the unemployed, and the retired are often
limited to specialty services if it is not deemed necessary or they
cannot afford the excessive fees. PPO plans often can schedule an
appointment with a specialist without permission from their primary
care provider, but those with an HMO or government-sponsored plan
do not have that option. Outpatient specialists are free to choose which
form of insurance they will accept, or whether they will accept it at
all. For example, not all specialists accept publicly insured patients,
because of the relatively lower reimbursement rates set by Medicaid
and Medicare. Access to specialists for beneficiaries of these
programs—not to mention for people without any insurance—can
therefore be particularly limited.
Coverage for Preexisting Conditions
In Japan, no one can be excluded from any coverage based on a
preexisting condition. This also became true in the United States.
lOMoARcPSD|61746433
Under current law, health insurance companies can’t refuse to cover
you or charge you more just because you have a 'pre-existing
condition', that is, a health problem you had before the date that new
health coverage starts.
Finance Implications for Healthcare Delivery
In Japan, people benefit from the universal healthcare delivery system.
All fees are determined by the government and therefore controlled.
Even though most hospitals and medical offices are privately run, they
are limited on what they can charge based on government regulations.
This allows individuals to seek medical treatment and preventative
services more often, thus leading to better health. Not only is health
benefited but a person benefits financially as well. Unlike Americans,
the Japanese do not need to worry that paying for healthcare will lead
to financial ruin. A hospital stay is in the hundreds, whereas in the
United States, it is in the thousand and can leave a person bankrupt.
Americans often go without medical treatment simply based on the
fact that they cannot afford it. Especially if they do not have health
insurance, like in the circumstance of losing a job. In Japan, if a
person loses their job their health coverage just switches from the
employer to a community plan.
The negative financial implications of Japan’s healthcare structure fall
on the providers. 50% of hospitals are in financial deficit. This is the
opposite in America, where hospitals and doctors make a profit at the
expense of the people. In America private practices can, and often do,
refuse services to those with government-sponsored insurance like
Medicaid. This is mostly due to the low reimbursement and the length
of time to receive payment. This is not allowed in Japan. There are
lOMoARcPSD|61746433
also disincentives for providers prescribing certain medications or
services because the price is then lowered upon the next government
review of fees. Again, this benefits the consumer, not the provider.
In America, both public and private insurers determine their benefit
packages and cost-sharing structures as long as it is within federal and
state regulations. Private insurers in America are for-profit, while
Japan’s statutory health insurance system (SHIS) is a not-for-profit
system. Insurers in Japan are not out to make a profit. Anything
money not used is carried over to the next year, which could lead to
premiums being reduced.
Conclusion
In summary, the comparative analysis covered in this essay has shown
that the healthcare systems of Japan and America, although they share
some common features, are nevertheless different. As for me, I would
prefer the Japanese system, for its accessibility, simplicity, and
orientation for the benefit of its population.
The United States does not have a universal healthcare system. Health
care coverage in the United States is a mixture of public and private,
as well as for-profit and nonprofit insurers. Options include fee-for-
service (FFS), preferred provider organization (PPO), point of service
(POS), health maintenance organization (HMO), Medicare, Medicaid,
and coverage from the Veterans Health Administration. A majority of
US citizens have private insurance that is often provided through their
employer, or they may buy it on their own. 12.5% of US adults are
uninsured, and countless more are underinsured. Lack of health
insurance is perhaps the greatest barrier to accessing health care
lOMoARcPSD|61746433
services and has a tremendous negative effect on an individual’s
overall health status.
The only thing close to a universal healthcare system in the United
States is the Patient Protection and Affordable Care Act ( PPACA),
which was signed into law in 2010. Its goal was to expand health
insurance coverage to Americans that were uninsured while
controlling costs and improving the quality of healthcare. Since its
beginning, it has been under scrutiny, and many parts have been
amended, including removing the penalty fee for those that did not
have health insurance. With the implementation of the PPACA,
different plan options became available for people to obtain insurance,
but private insurance is the primary health coverage for two-thirds of
Americans (67%). Over half of all private insurance is through
employers. Most employer plans cover their employees and give
various options on the level of coverage and also the option to insure
their family. Rarely an employer pays the entire premium. Most of the
time the cost is shared between the employer and employee. Only
11% of private health insurance is purchased by individuals from for-
profit and nonprofit carriers.
In America, retirees/seniors qualify for Medicare. It is a complex fee-
for-service program consisting of parts, A-D. Part A provides hospital
insurance and Part B medical insurance. Members can choose to get
their coverage just through traditional Medicare, or they can choose to
enroll in Part C which is a private health maintenance organization
(HMO) called Medicare Advantage. Part D is also optional and is for
prescription drug coverage. Medicare is financed through a
lOMoARcPSD|61746433
combination of general federal taxes, a mandatory payroll tax that
pays for Part A, and individual premiums.
The unemployed may qualify for Medicaid if their income is low. It is
a jointly sponsored state and federal program that pays for medical
services for persons who are elderly, poor, blind, or disabled, and for
certain families with dependent children who meet specified income
guidelines. Medicaid is obtained through the state of residency. The
state then received federal matching for providing the health coverage.
Veterans can receive healthcare coverage from the Veterans Health
Administration. It is America’s largest integrated healthcare system
serving 9 million enrolled Veterans each year. Having other health
insurance coverage like Medicare, Medicaid, or private insurance
doesn’t affect getting VA healthcare benefits. Each veteran’s medical
benefits package is unique. Covered benefits depend on the 'priority
group' and the advice of the VA primary provider. Retiring veterans
may also be eligible for TRICARE. It is a Medicare-wraparound
coverage for those that have Medicare Part A and B.
There are two US government-run programs available to children
from low-income households. Depending on income level, they may
qualify for Medicaid or the Children’s Health Insurance Program
(CHIP). CHIP is a state-administered public program created in 1997
for children in low-income families that earn too much to qualify for
Medicaid but are unlikely to be able to afford private insurance. CHIP
is funded through matching grants from the federal government to the
states, and most states charge a low premium and have small copays,
if any. Because it is state-administered, exactly how it works varies by
state. For example, it is considered an extension of Medicaid in some
lOMoARcPSD|61746433
states, while in others it is a separate program. Currently, 9.6 million
children are covered by this program.
Coverage of Medications
In Japan, the coverage for medication for children, the unemployed,
and the retired remain under the same rules as the coinsurance
percentages. Clinics can dispense medication directly to the patients or
they can go to the pharmacy. According to the Commonwealth Fund,
the use of pharmacies has been growing. Price revisions for
medications are also revised every 2 years. Usually, prices are lowered
for new drugs that are selling more than expected, and for brand-name
drugs when their generic counterparts become available. Prices of
generic drugs have gradually decreased. Also, if a physician
prescribes more than 6 drugs regularly to a patient, he receives a
reduced fee as a way to improve clinical decision-making.
In the US, the coverage for medication for children, the unemployed,
the and retired depends on the coverage they have.
Retired individuals with Medicare have the option to purchase private
prescription drug coverage under Medicare Part D. Part D covers most
outpatient drugs, like those that you would get a prescription for and
pick up at the pharmacy. Medicare Part B only covers very limited
outpatient prescription drug benefits, like injections that need to be
given by a medical professional. For Medicare Part D, copays and
coinsurance vary by drug plan: $0–$5 for preferred generics, up to
50% for non-preferred drugs. For the unemployed that qualify for
Medicaid, outpatient prescription drugs are an optional benefit under
federal law, however, currently, all states provide drug coverage. For
children with private health insurance, the copay for prescriptions
lOMoARcPSD|61746433
depends on that specific insurance coverage. For low-income children,
the copay for medications is reduced if part of CHIP or possibly free if
on Medicaid. Vaccines are often free to uninsured and underinsured
children.
Referral to See a Specialist
In Japan, there is no 'gatekeeper'. Children, the unemployed, and the
retired do not need to get a referral to go see a specialist. The term
'general practice' in Japan is recent, but historically, there has been no
distinction between primary care and specialty care. The fee schedule
remains the same for all providers. Patients can see a specialist
without a referral and most of the time on a walk-in basis.
A 'gatekeeper' is very common for healthcare coverage in the United
States. American children, the unemployed, and the retired are often
limited to specialty services if it is not deemed necessary or they
cannot afford the excessive fees. PPO plans often can schedule an
appointment with a specialist without permission from their primary
care provider, but those with an HMO or government-sponsored plan
do not have that option. Outpatient specialists are free to choose which
form of insurance they will accept, or whether they will accept it at
all. For example, not all specialists accept publicly insured patients,
because of the relatively lower reimbursement rates set by Medicaid
and Medicare. Access to specialists for beneficiaries of these
programs—not to mention for people without any insurance—can
therefore be particularly limited.
Coverage for Preexisting Conditions
In Japan, no one can be excluded from any coverage based on a
preexisting condition. This also became true in the United States.
lOMoARcPSD|61746433
Under current law, health insurance companies can’t refuse to cover
you or charge you more just because you have a 'pre-existing
condition', that is, a health problem you had before the date that new
health coverage starts.
Finance Implications for Healthcare Delivery
In Japan, people benefit from the universal healthcare delivery system.
All fees are determined by the government and therefore controlled.
Even though most hospitals and medical offices are privately run, they
are limited on what they can charge based on government regulations.
This allows individuals to seek medical treatment and preventative
services more often, thus leading to better health. Not only is health
benefited but a person benefits financially as well. Unlike Americans,
the Japanese do not need to worry that paying for healthcare will lead
to financial ruin. A hospital stay is in the hundreds, whereas in the
United States, it is in the thousand and can leave a person bankrupt.
Americans often go without medical treatment simply based on the
fact that they cannot afford it. Especially if they do not have health
insurance, like in the circumstance of losing a job. In Japan, if a
person loses their job their health coverage just switches from the
employer to a community plan.
The negative financial implications of Japan’s healthcare structure fall
on the providers. 50% of hospitals are in financial deficit. This is the
opposite in America, where hospitals and doctors make a profit at the
expense of the people. In America private practices can, and often do,
refuse services to those with government-sponsored insurance like
Medicaid. This is mostly due to the low reimbursement and the length
of time to receive payment. This is not allowed in Japan. There are
lOMoARcPSD|61746433
also disincentives for providers prescribing certain medications or
services because the price is then lowered upon the next government
review of fees. Again, this benefits the consumer, not the provider.
In America, both public and private insurers determine their benefit
packages and cost-sharing structures as long as it is within federal and
state regulations. Private insurers in America are for-profit, while
Japan’s statutory health insurance system (SHIS) is a not-for-profit
system. Insurers in Japan are not out to make a profit. Anything
money not used is carried over to the next year, which could lead to
premiums being reduced.
Conclusion
In summary, the comparative analysis covered in this essay has shown
that the healthcare systems of Japan and America, although they share
some common features, are nevertheless different. As for me, I would
prefer the Japanese system, for its accessibility, simplicity, and
orientation for the benefit of its population.
The United States does not have a universal healthcare system. Health
care coverage in the United States is a mixture of public and private,
as well as for-profit and nonprofit insurers. Options include fee-for-
service (FFS), preferred provider organization (PPO), point of service
(POS), health maintenance organization (HMO), Medicare, Medicaid,
and coverage from the Veterans Health Administration. A majority of
US citizens have private insurance that is often provided through their
employer, or they may buy it on their own. 12.5% of US adults are
uninsured, and countless more are underinsured. Lack of health
insurance is perhaps the greatest barrier to accessing health care
lOMoARcPSD|61746433
services and has a tremendous negative effect on an individual’s
overall health status.
The only thing close to a universal healthcare system in the United
States is the Patient Protection and Affordable Care Act ( PPACA),
which was signed into law in 2010. Its goal was to expand health
insurance coverage to Americans that were uninsured while
controlling costs and improving the quality of healthcare. Since its
beginning, it has been under scrutiny, and many parts have been
amended, including removing the penalty fee for those that did not
have health insurance. With the implementation of the PPACA,
different plan options became available for people to obtain insurance,
but private insurance is the primary health coverage for two-thirds of
Americans (67%). Over half of all private insurance is through
employers. Most employer plans cover their employees and give
various options on the level of coverage and also the option to insure
their family. Rarely an employer pays the entire premium. Most of the
time the cost is shared between the employer and employee. Only
11% of private health insurance is purchased by individuals from for-
profit and nonprofit carriers.
In America, retirees/seniors qualify for Medicare. It is a complex fee-
for-service program consisting of parts, A-D. Part A provides hospital
insurance and Part B medical insurance. Members can choose to get
their coverage just through traditional Medicare, or they can choose to
enroll in Part C which is a private health maintenance organization
(HMO) called Medicare Advantage. Part D is also optional and is for
prescription drug coverage. Medicare is financed through a
lOMoARcPSD|61746433
combination of general federal taxes, a mandatory payroll tax that
pays for Part A, and individual premiums.
The unemployed may qualify for Medicaid if their income is low. It is
a jointly sponsored state and federal program that pays for medical
services for persons who are elderly, poor, blind, or disabled, and for
certain families with dependent children who meet specified income
guidelines. Medicaid is obtained through the state of residency. The
state then received federal matching for providing the health coverage.
Veterans can receive healthcare coverage from the Veterans Health
Administration. It is America’s largest integrated healthcare system
serving 9 million enrolled Veterans each year. Having other health
insurance coverage like Medicare, Medicaid, or private insurance
doesn’t affect getting VA healthcare benefits. Each veteran’s medical
benefits package is unique. Covered benefits depend on the 'priority
group' and the advice of the VA primary provider. Retiring veterans
may also be eligible for TRICARE. It is a Medicare-wraparound
coverage for those that have Medicare Part A and B.
There are two US government-run programs available to children
from low-income households. Depending on income level, they may
qualify for Medicaid or the Children’s Health Insurance Program
(CHIP). CHIP is a state-administered public program created in 1997
for children in low-income families that earn too much to qualify for
Medicaid but are unlikely to be able to afford private insurance. CHIP
is funded through matching grants from the federal government to the
states, and most states charge a low premium and have small copays,
if any. Because it is state-administered, exactly how it works varies by
state. For example, it is considered an extension of Medicaid in some
lOMoARcPSD|61746433
states, while in others it is a separate program. Currently, 9.6 million
children are covered by this program.
Coverage of Medications
In Japan, the coverage for medication for children, the unemployed,
and the retired remain under the same rules as the coinsurance
percentages. Clinics can dispense medication directly to the patients or
they can go to the pharmacy. According to the Commonwealth Fund,
the use of pharmacies has been growing. Price revisions for
medications are also revised every 2 years. Usually, prices are lowered
for new drugs that are selling more than expected, and for brand-name
drugs when their generic counterparts become available. Prices of
generic drugs have gradually decreased. Also, if a physician
prescribes more than 6 drugs regularly to a patient, he receives a
reduced fee as a way to improve clinical decision-making.
In the US, the coverage for medication for children, the unemployed,
the and retired depends on the coverage they have.
Retired individuals with Medicare have the option to purchase private
prescription drug coverage under Medicare Part D. Part D covers most
outpatient drugs, like those that you would get a prescription for and
pick up at the pharmacy. Medicare Part B only covers very limited
outpatient prescription drug benefits, like injections that need to be
given by a medical professional. For Medicare Part D, copays and
coinsurance vary by drug plan: $0–$5 for preferred generics, up to
50% for non-preferred drugs. For the unemployed that qualify for
Medicaid, outpatient prescription drugs are an optional benefit under
federal law, however, currently, all states provide drug coverage. For
children with private health insurance, the copay for prescriptions
lOMoARcPSD|61746433
depends on that specific insurance coverage. For low-income children,
the copay for medications is reduced if part of CHIP or possibly free if
on Medicaid. Vaccines are often free to uninsured and underinsured
children.
Referral to See a Specialist
In Japan, there is no 'gatekeeper'. Children, the unemployed, and the
retired do not need to get a referral to go see a specialist. The term
'general practice' in Japan is recent, but historically, there has been no
distinction between primary care and specialty care. The fee schedule
remains the same for all providers. Patients can see a specialist
without a referral and most of the time on a walk-in basis.
A 'gatekeeper' is very common for healthcare coverage in the United
States. American children, the unemployed, and the retired are often
limited to specialty services if it is not deemed necessary or they
cannot afford the excessive fees. PPO plans often can schedule an
appointment with a specialist without permission from their primary
care provider, but those with an HMO or government-sponsored plan
do not have that option. Outpatient specialists are free to choose which
form of insurance they will accept, or whether they will accept it at
all. For example, not all specialists accept publicly insured patients,
because of the relatively lower reimbursement rates set by Medicaid
and Medicare. Access to specialists for beneficiaries of these
programs—not to mention for people without any insurance—can
therefore be particularly limited.
Coverage for Preexisting Conditions
In Japan, no one can be excluded from any coverage based on a
preexisting condition. This also became true in the United States.
lOMoARcPSD|61746433
Under current law, health insurance companies can’t refuse to cover
you or charge you more just because you have a 'pre-existing
condition', that is, a health problem you had before the date that new
health coverage starts.
Finance Implications for Healthcare Delivery
In Japan, people benefit from the universal healthcare delivery system.
All fees are determined by the government and therefore controlled.
Even though most hospitals and medical offices are privately run, they
are limited on what they can charge based on government regulations.
This allows individuals to seek medical treatment and preventative
services more often, thus leading to better health. Not only is health
benefited but a person benefits financially as well. Unlike Americans,
the Japanese do not need to worry that paying for healthcare will lead
to financial ruin. A hospital stay is in the hundreds, whereas in the
United States, it is in the thousand and can leave a person bankrupt.
Americans often go without medical treatment simply based on the
fact that they cannot afford it. Especially if they do not have health
insurance, like in the circumstance of losing a job. In Japan, if a
person loses their job their health coverage just switches from the
employer to a community plan.
The negative financial implications of Japan’s healthcare structure fall
on the providers. 50% of hospitals are in financial deficit. This is the
opposite in America, where hospitals and doctors make a profit at the
expense of the people. In America private practices can, and often do,
refuse services to those with government-sponsored insurance like
Medicaid. This is mostly due to the low reimbursement and the length
of time to receive payment. This is not allowed in Japan. There are
lOMoARcPSD|61746433
also disincentives for providers prescribing certain medications or
services because the price is then lowered upon the next government
review of fees. Again, this benefits the consumer, not the provider.
In America, both public and private insurers determine their benefit
packages and cost-sharing structures as long as it is within federal and
state regulations. Private insurers in America are for-profit, while
Japan’s statutory health insurance system (SHIS) is a not-for-profit
system. Insurers in Japan are not out to make a profit. Anything
money not used is carried over to the next year, which could lead to
premiums being reduced.
Conclusion
In summary, the comparative analysis covered in this essay has shown
that the healthcare systems of Japan and America, although they share
some common features, are nevertheless different. As for me, I would
prefer the Japanese system, for its accessibility, simplicity, and
orientation for the benefit of its population.
The United States does not have a universal healthcare system. Health
care coverage in the United States is a mixture of public and private,
as well as for-profit and nonprofit insurers. Options include fee-for-
service (FFS), preferred provider organization (PPO), point of service
(POS), health maintenance organization (HMO), Medicare, Medicaid,
and coverage from the Veterans Health Administration. A majority of
US citizens have private insurance that is often provided through their
employer, or they may buy it on their own. 12.5% of US adults are
uninsured, and countless more are underinsured. Lack of health
insurance is perhaps the greatest barrier to accessing health care
lOMoARcPSD|61746433
services and has a tremendous negative effect on an individual’s
overall health status.
The only thing close to a universal healthcare system in the United
States is the Patient Protection and Affordable Care Act ( PPACA),
which was signed into law in 2010. Its goal was to expand health
insurance coverage to Americans that were uninsured while
controlling costs and improving the quality of healthcare. Since its
beginning, it has been under scrutiny, and many parts have been
amended, including removing the penalty fee for those that did not
have health insurance. With the implementation of the PPACA,
different plan options became available for people to obtain insurance,
but private insurance is the primary health coverage for two-thirds of
Americans (67%). Over half of all private insurance is through
employers. Most employer plans cover their employees and give
various options on the level of coverage and also the option to insure
their family. Rarely an employer pays the entire premium. Most of the
time the cost is shared between the employer and employee. Only
11% of private health insurance is purchased by individuals from for-
profit and nonprofit carriers.
In America, retirees/seniors qualify for Medicare. It is a complex fee-
for-service program consisting of parts, A-D. Part A provides hospital
insurance and Part B medical insurance. Members can choose to get
their coverage just through traditional Medicare, or they can choose to
enroll in Part C which is a private health maintenance organization
(HMO) called Medicare Advantage. Part D is also optional and is for
prescription drug coverage. Medicare is financed through a
lOMoARcPSD|61746433
combination of general federal taxes, a mandatory payroll tax that
pays for Part A, and individual premiums.
The unemployed may qualify for Medicaid if their income is low. It is
a jointly sponsored state and federal program that pays for medical
services for persons who are elderly, poor, blind, or disabled, and for
certain families with dependent children who meet specified income
guidelines. Medicaid is obtained through the state of residency. The
state then received federal matching for providing the health coverage.
Veterans can receive healthcare coverage from the Veterans Health
Administration. It is America’s largest integrated healthcare system
serving 9 million enrolled Veterans each year. Having other health
insurance coverage like Medicare, Medicaid, or private insurance
doesn’t affect getting VA healthcare benefits. Each veteran’s medical
benefits package is unique. Covered benefits depend on the 'priority
group' and the advice of the VA primary provider. Retiring veterans
may also be eligible for TRICARE. It is a Medicare-wraparound
coverage for those that have Medicare Part A and B.
There are two US government-run programs available to children
from low-income households. Depending on income level, they may
qualify for Medicaid or the Children’s Health Insurance Program
(CHIP). CHIP is a state-administered public program created in 1997
for children in low-income families that earn too much to qualify for
Medicaid but are unlikely to be able to afford private insurance. CHIP
is funded through matching grants from the federal government to the
states, and most states charge a low premium and have small copays,
if any. Because it is state-administered, exactly how it works varies by
state. For example, it is considered an extension of Medicaid in some
lOMoARcPSD|61746433
states, while in others it is a separate program. Currently, 9.6 million
children are covered by this program.
Coverage of Medications
In Japan, the coverage for medication for children, the unemployed,
and the retired remain under the same rules as the coinsurance
percentages. Clinics can dispense medication directly to the patients or
they can go to the pharmacy. According to the Commonwealth Fund,
the use of pharmacies has been growing. Price revisions for
medications are also revised every 2 years. Usually, prices are lowered
for new drugs that are selling more than expected, and for brand-name
drugs when their generic counterparts become available. Prices of
generic drugs have gradually decreased. Also, if a physician
prescribes more than 6 drugs regularly to a patient, he receives a
reduced fee as a way to improve clinical decision-making.
In the US, the coverage for medication for children, the unemployed,
the and retired depends on the coverage they have.
Retired individuals with Medicare have the option to purchase private
prescription drug coverage under Medicare Part D. Part D covers most
outpatient drugs, like those that you would get a prescription for and
pick up at the pharmacy. Medicare Part B only covers very limited
outpatient prescription drug benefits, like injections that need to be
given by a medical professional. For Medicare Part D, copays and
coinsurance vary by drug plan: $0–$5 for preferred generics, up to
50% for non-preferred drugs. For the unemployed that qualify for
Medicaid, outpatient prescription drugs are an optional benefit under
federal law, however, currently, all states provide drug coverage. For
children with private health insurance, the copay for prescriptions
lOMoARcPSD|61746433
depends on that specific insurance coverage. For low-income children,
the copay for medications is reduced if part of CHIP or possibly free if
on Medicaid. Vaccines are often free to uninsured and underinsured
children.
Referral to See a Specialist
In Japan, there is no 'gatekeeper'. Children, the unemployed, and the
retired do not need to get a referral to go see a specialist. The term
'general practice' in Japan is recent, but historically, there has been no
distinction between primary care and specialty care. The fee schedule
remains the same for all providers. Patients can see a specialist
without a referral and most of the time on a walk-in basis.
A 'gatekeeper' is very common for healthcare coverage in the United
States. American children, the unemployed, and the retired are often
limited to specialty services if it is not deemed necessary or they
cannot afford the excessive fees. PPO plans often can schedule an
appointment with a specialist without permission from their primary
care provider, but those with an HMO or government-sponsored plan
do not have that option. Outpatient specialists are free to choose which
form of insurance they will accept, or whether they will accept it at
all. For example, not all specialists accept publicly insured patients,
because of the relatively lower reimbursement rates set by Medicaid
and Medicare. Access to specialists for beneficiaries of these
programs—not to mention for people without any insurance—can
therefore be particularly limited.
Coverage for Preexisting Conditions
In Japan, no one can be excluded from any coverage based on a
preexisting condition. This also became true in the United States.
lOMoARcPSD|61746433
Under current law, health insurance companies can’t refuse to cover
you or charge you more just because you have a 'pre-existing
condition', that is, a health problem you had before the date that new
health coverage starts.
Finance Implications for Healthcare Delivery
In Japan, people benefit from the universal healthcare delivery system.
All fees are determined by the government and therefore controlled.
Even though most hospitals and medical offices are privately run, they
are limited on what they can charge based on government regulations.
This allows individuals to seek medical treatment and preventative
services more often, thus leading to better health. Not only is health
benefited but a person benefits financially as well. Unlike Americans,
the Japanese do not need to worry that paying for healthcare will lead
to financial ruin. A hospital stay is in the hundreds, whereas in the
United States, it is in the thousand and can leave a person bankrupt.
Americans often go without medical treatment simply based on the
fact that they cannot afford it. Especially if they do not have health
insurance, like in the circumstance of losing a job. In Japan, if a
person loses their job their health coverage just switches from the
employer to a community plan.
The negative financial implications of Japan’s healthcare structure fall
on the providers. 50% of hospitals are in financial deficit. This is the
opposite in America, where hospitals and doctors make a profit at the
expense of the people. In America private practices can, and often do,
refuse services to those with government-sponsored insurance like
Medicaid. This is mostly due to the low reimbursement and the length
of time to receive payment. This is not allowed in Japan. There are
lOMoARcPSD|61746433
also disincentives for providers prescribing certain medications or
services because the price is then lowered upon the next government
review of fees. Again, this benefits the consumer, not the provider.
In America, both public and private insurers determine their benefit
packages and cost-sharing structures as long as it is within federal and
state regulations. Private insurers in America are for-profit, while
Japan’s statutory health insurance system (SHIS) is a not-for-profit
system. Insurers in Japan are not out to make a profit. Anything
money not used is carried over to the next year, which could lead to
premiums being reduced.
Conclusion
In summary, the comparative analysis covered in this essay has shown
that the healthcare systems of Japan and America, although they share
some common features, are nevertheless different. As for me, I would
prefer the Japanese system, for its accessibility, simplicity, and
orientation for the benefit of its population.
The United States does not have a universal healthcare system. Health
care coverage in the United States is a mixture of public and private,
as well as for-profit and nonprofit insurers. Options include fee-for-
service (FFS), preferred provider organization (PPO), point of service
(POS), health maintenance organization (HMO), Medicare, Medicaid,
and coverage from the Veterans Health Administration. A majority of
US citizens have private insurance that is often provided through their
employer, or they may buy it on their own. 12.5% of US adults are
uninsured, and countless more are underinsured. Lack of health
insurance is perhaps the greatest barrier to accessing health care
lOMoARcPSD|61746433
services and has a tremendous negative effect on an individual’s
overall health status.
The only thing close to a universal healthcare system in the United
States is the Patient Protection and Affordable Care Act ( PPACA),
which was signed into law in 2010. Its goal was to expand health
insurance coverage to Americans that were uninsured while
controlling costs and improving the quality of healthcare. Since its
beginning, it has been under scrutiny, and many parts have been
amended, including removing the penalty fee for those that did not
have health insurance. With the implementation of the PPACA,
different plan options became available for people to obtain insurance,
but private insurance is the primary health coverage for two-thirds of
Americans (67%). Over half of all private insurance is through
employers. Most employer plans cover their employees and give
various options on the level of coverage and also the option to insure
their family. Rarely an employer pays the entire premium. Most of the
time the cost is shared between the employer and employee. Only
11% of private health insurance is purchased by individuals from for-
profit and nonprofit carriers.
In America, retirees/seniors qualify for Medicare. It is a complex fee-
for-service program consisting of parts, A-D. Part A provides hospital
insurance and Part B medical insurance. Members can choose to get
their coverage just through traditional Medicare, or they can choose to
enroll in Part C which is a private health maintenance organization
(HMO) called Medicare Advantage. Part D is also optional and is for
prescription drug coverage. Medicare is financed through a
lOMoARcPSD|61746433
combination of general federal taxes, a mandatory payroll tax that
pays for Part A, and individual premiums.
The unemployed may qualify for Medicaid if their income is low. It is
a jointly sponsored state and federal program that pays for medical
services for persons who are elderly, poor, blind, or disabled, and for
certain families with dependent children who meet specified income
guidelines. Medicaid is obtained through the state of residency. The
state then received federal matching for providing the health coverage.
Veterans can receive healthcare coverage from the Veterans Health
Administration. It is America’s largest integrated healthcare system
serving 9 million enrolled Veterans each year. Having other health
insurance coverage like Medicare, Medicaid, or private insurance
doesn’t affect getting VA healthcare benefits. Each veteran’s medical
benefits package is unique. Covered benefits depend on the 'priority
group' and the advice of the VA primary provider. Retiring veterans
may also be eligible for TRICARE. It is a Medicare-wraparound
coverage for those that have Medicare Part A and B.
There are two US government-run programs available to children
from low-income households. Depending on income level, they may
qualify for Medicaid or the Children’s Health Insurance Program
(CHIP). CHIP is a state-administered public program created in 1997
for children in low-income families that earn too much to qualify for
Medicaid but are unlikely to be able to afford private insurance. CHIP
is funded through matching grants from the federal government to the
states, and most states charge a low premium and have small copays,
if any. Because it is state-administered, exactly how it works varies by
state. For example, it is considered an extension of Medicaid in some
lOMoARcPSD|61746433
states, while in others it is a separate program. Currently, 9.6 million
children are covered by this program.
Coverage of Medications
In Japan, the coverage for medication for children, the unemployed,
and the retired remain under the same rules as the coinsurance
percentages. Clinics can dispense medication directly to the patients or
they can go to the pharmacy. According to the Commonwealth Fund,
the use of pharmacies has been growing. Price revisions for
medications are also revised every 2 years. Usually, prices are lowered
for new drugs that are selling more than expected, and for brand-name
drugs when their generic counterparts become available. Prices of
generic drugs have gradually decreased. Also, if a physician
prescribes more than 6 drugs regularly to a patient, he receives a
reduced fee as a way to improve clinical decision-making.
In the US, the coverage for medication for children, the unemployed,
the and retired depends on the coverage they have.
Retired individuals with Medicare have the option to purchase private
prescription drug coverage under Medicare Part D. Part D covers most
outpatient drugs, like those that you would get a prescription for and
pick up at the pharmacy. Medicare Part B only covers very limited
outpatient prescription drug benefits, like injections that need to be
given by a medical professional. For Medicare Part D, copays and
coinsurance vary by drug plan: $0–$5 for preferred generics, up to
50% for non-preferred drugs. For the unemployed that qualify for
Medicaid, outpatient prescription drugs are an optional benefit under
federal law, however, currently, all states provide drug coverage. For
children with private health insurance, the copay for prescriptions
lOMoARcPSD|61746433
depends on that specific insurance coverage. For low-income children,
the copay for medications is reduced if part of CHIP or possibly free if
on Medicaid. Vaccines are often free to uninsured and underinsured
children.
Referral to See a Specialist
In Japan, there is no 'gatekeeper'. Children, the unemployed, and the
retired do not need to get a referral to go see a specialist. The term
'general practice' in Japan is recent, but historically, there has been no
distinction between primary care and specialty care. The fee schedule
remains the same for all providers. Patients can see a specialist
without a referral and most of the time on a walk-in basis.
A 'gatekeeper' is very common for healthcare coverage in the United
States. American children, the unemployed, and the retired are often
limited to specialty services if it is not deemed necessary or they
cannot afford the excessive fees. PPO plans often can schedule an
appointment with a specialist without permission from their primary
care provider, but those with an HMO or government-sponsored plan
do not have that option. Outpatient specialists are free to choose which
form of insurance they will accept, or whether they will accept it at
all. For example, not all specialists accept publicly insured patients,
because of the relatively lower reimbursement rates set by Medicaid
and Medicare. Access to specialists for beneficiaries of these
programs—not to mention for people without any insurance—can
therefore be particularly limited.
Coverage for Preexisting Conditions
In Japan, no one can be excluded from any coverage based on a
preexisting condition. This also became true in the United States.
lOMoARcPSD|61746433
Under current law, health insurance companies can’t refuse to cover
you or charge you more just because you have a 'pre-existing
condition', that is, a health problem you had before the date that new
health coverage starts.
Finance Implications for Healthcare Delivery
In Japan, people benefit from the universal healthcare delivery system.
All fees are determined by the government and therefore controlled.
Even though most hospitals and medical offices are privately run, they
are limited on what they can charge based on government regulations.
This allows individuals to seek medical treatment and preventative
services more often, thus leading to better health. Not only is health
benefited but a person benefits financially as well. Unlike Americans,
the Japanese do not need to worry that paying for healthcare will lead
to financial ruin. A hospital stay is in the hundreds, whereas in the
United States, it is in the thousand and can leave a person bankrupt.
Americans often go without medical treatment simply based on the
fact that they cannot afford it. Especially if they do not have health
insurance, like in the circumstance of losing a job. In Japan, if a
person loses their job their health coverage just switches from the
employer to a community plan.
The negative financial implications of Japan’s healthcare structure fall
on the providers. 50% of hospitals are in financial deficit. This is the
opposite in America, where hospitals and doctors make a profit at the
expense of the people. In America private practices can, and often do,
refuse services to those with government-sponsored insurance like
Medicaid. This is mostly due to the low reimbursement and the length
of time to receive payment. This is not allowed in Japan. There are
lOMoARcPSD|61746433
also disincentives for providers prescribing certain medications or
services because the price is then lowered upon the next government
review of fees. Again, this benefits the consumer, not the provider.
In America, both public and private insurers determine their benefit
packages and cost-sharing structures as long as it is within federal and
state regulations. Private insurers in America are for-profit, while
Japan’s statutory health insurance system (SHIS) is a not-for-profit
system. Insurers in Japan are not out to make a profit. Anything
money not used is carried over to the next year, which could lead to
premiums being reduced.
Conclusion
In summary, the comparative analysis covered in this essay has shown
that the healthcare systems of Japan and America, although they share
some common features, are nevertheless different. As for me, I would
prefer the Japanese system, for its accessibility, simplicity, and
orientation for the benefit of its population.
The United States does not have a universal healthcare system. Health
care coverage in the United States is a mixture of public and private,
as well as for-profit and nonprofit insurers. Options include fee-for-
service (FFS), preferred provider organization (PPO), point of service
(POS), health maintenance organization (HMO), Medicare, Medicaid,
and coverage from the Veterans Health Administration. A majority of
US citizens have private insurance that is often provided through their
employer, or they may buy it on their own. 12.5% of US adults are
uninsured, and countless more are underinsured. Lack of health
insurance is perhaps the greatest barrier to accessing health care
lOMoARcPSD|61746433
services and has a tremendous negative effect on an individual’s
overall health status.
The only thing close to a universal healthcare system in the United
States is the Patient Protection and Affordable Care Act ( PPACA),
which was signed into law in 2010. Its goal was to expand health
insurance coverage to Americans that were uninsured while
controlling costs and improving the quality of healthcare. Since its
beginning, it has been under scrutiny, and many parts have been
amended, including removing the penalty fee for those that did not
have health insurance. With the implementation of the PPACA,
different plan options became available for people to obtain insurance,
but private insurance is the primary health coverage for two-thirds of
Americans (67%). Over half of all private insurance is through
employers. Most employer plans cover their employees and give
various options on the level of coverage and also the option to insure
their family. Rarely an employer pays the entire premium. Most of the
time the cost is shared between the employer and employee. Only
11% of private health insurance is purchased by individuals from for-
profit and nonprofit carriers.
In America, retirees/seniors qualify for Medicare. It is a complex fee-
for-service program consisting of parts, A-D. Part A provides hospital
insurance and Part B medical insurance. Members can choose to get
their coverage just through traditional Medicare, or they can choose to
enroll in Part C which is a private health maintenance organization
(HMO) called Medicare Advantage. Part D is also optional and is for
prescription drug coverage. Medicare is financed through a
lOMoARcPSD|61746433
combination of general federal taxes, a mandatory payroll tax that
pays for Part A, and individual premiums.
The unemployed may qualify for Medicaid if their income is low. It is
a jointly sponsored state and federal program that pays for medical
services for persons who are elderly, poor, blind, or disabled, and for
certain families with dependent children who meet specified income
guidelines. Medicaid is obtained through the state of residency. The
state then received federal matching for providing the health coverage.
Veterans can receive healthcare coverage from the Veterans Health
Administration. It is America’s largest integrated healthcare system
serving 9 million enrolled Veterans each year. Having other health
insurance coverage like Medicare, Medicaid, or private insurance
doesn’t affect getting VA healthcare benefits. Each veteran’s medical
benefits package is unique. Covered benefits depend on the 'priority
group' and the advice of the VA primary provider. Retiring veterans
may also be eligible for TRICARE. It is a Medicare-wraparound
coverage for those that have Medicare Part A and B.
There are two US government-run programs available to children
from low-income households. Depending on income level, they may
qualify for Medicaid or the Children’s Health Insurance Program
(CHIP). CHIP is a state-administered public program created in 1997
for children in low-income families that earn too much to qualify for
Medicaid but are unlikely to be able to afford private insurance. CHIP
is funded through matching grants from the federal government to the
states, and most states charge a low premium and have small copays,
if any. Because it is state-administered, exactly how it works varies by
state. For example, it is considered an extension of Medicaid in some
lOMoARcPSD|61746433
states, while in others it is a separate program. Currently, 9.6 million
children are covered by this program.
Coverage of Medications
In Japan, the coverage for medication for children, the unemployed,
and the retired remain under the same rules as the coinsurance
percentages. Clinics can dispense medication directly to the patients or
they can go to the pharmacy. According to the Commonwealth Fund,
the use of pharmacies has been growing. Price revisions for
medications are also revised every 2 years. Usually, prices are lowered
for new drugs that are selling more than expected, and for brand-name
drugs when their generic counterparts become available. Prices of
generic drugs have gradually decreased. Also, if a physician
prescribes more than 6 drugs regularly to a patient, he receives a
reduced fee as a way to improve clinical decision-making.
In the US, the coverage for medication for children, the unemployed,
the and retired depends on the coverage they have.
Retired individuals with Medicare have the option to purchase private
prescription drug coverage under Medicare Part D. Part D covers most
outpatient drugs, like those that you would get a prescription for and
pick up at the pharmacy. Medicare Part B only covers very limited
outpatient prescription drug benefits, like injections that need to be
given by a medical professional. For Medicare Part D, copays and
coinsurance vary by drug plan: $0–$5 for preferred generics, up to
50% for non-preferred drugs. For the unemployed that qualify for
Medicaid, outpatient prescription drugs are an optional benefit under
federal law, however, currently, all states provide drug coverage. For
children with private health insurance, the copay for prescriptions
lOMoARcPSD|61746433
depends on that specific insurance coverage. For low-income children,
the copay for medications is reduced if part of CHIP or possibly free if
on Medicaid. Vaccines are often free to uninsured and underinsured
children.
Referral to See a Specialist
In Japan, there is no 'gatekeeper'. Children, the unemployed, and the
retired do not need to get a referral to go see a specialist. The term
'general practice' in Japan is recent, but historically, there has been no
distinction between primary care and specialty care. The fee schedule
remains the same for all providers. Patients can see a specialist
without a referral and most of the time on a walk-in basis.
A 'gatekeeper' is very common for healthcare coverage in the United
States. American children, the unemployed, and the retired are often
limited to specialty services if it is not deemed necessary or they
cannot afford the excessive fees. PPO plans often can schedule an
appointment with a specialist without permission from their primary
care provider, but those with an HMO or government-sponsored plan
do not have that option. Outpatient specialists are free to choose which
form of insurance they will accept, or whether they will accept it at
all. For example, not all specialists accept publicly insured patients,
because of the relatively lower reimbursement rates set by Medicaid
and Medicare. Access to specialists for beneficiaries of these
programs—not to mention for people without any insurance—can
therefore be particularly limited.
Coverage for Preexisting Conditions
In Japan, no one can be excluded from any coverage based on a
preexisting condition. This also became true in the United States.
lOMoARcPSD|61746433
Under current law, health insurance companies can’t refuse to cover
you or charge you more just because you have a 'pre-existing
condition', that is, a health problem you had before the date that new
health coverage starts.
Finance Implications for Healthcare Delivery
In Japan, people benefit from the universal healthcare delivery system.
All fees are determined by the government and therefore controlled.
Even though most hospitals and medical offices are privately run, they
are limited on what they can charge based on government regulations.
This allows individuals to seek medical treatment and preventative
services more often, thus leading to better health. Not only is health
benefited but a person benefits financially as well. Unlike Americans,
the Japanese do not need to worry that paying for healthcare will lead
to financial ruin. A hospital stay is in the hundreds, whereas in the
United States, it is in the thousand and can leave a person bankrupt.
Americans often go without medical treatment simply based on the
fact that they cannot afford it. Especially if they do not have health
insurance, like in the circumstance of losing a job. In Japan, if a
person loses their job their health coverage just switches from the
employer to a community plan.
The negative financial implications of Japan’s healthcare structure fall
on the providers. 50% of hospitals are in financial deficit. This is the
opposite in America, where hospitals and doctors make a profit at the
expense of the people. In America private practices can, and often do,
refuse services to those with government-sponsored insurance like
Medicaid. This is mostly due to the low reimbursement and the length
of time to receive payment. This is not allowed in Japan. There are
lOMoARcPSD|61746433
also disincentives for providers prescribing certain medications or
services because the price is then lowered upon the next government
review of fees. Again, this benefits the consumer, not the provider.
In America, both public and private insurers determine their benefit
packages and cost-sharing structures as long as it is within federal and
state regulations. Private insurers in America are for-profit, while
Japan’s statutory health insurance system (SHIS) is a not-for-profit
system. Insurers in Japan are not out to make a profit. Anything
money not used is carried over to the next year, which could lead to
premiums being reduced.
Conclusion
In summary, the comparative analysis covered in this essay has shown
that the healthcare systems of Japan and America, although they share
some common features, are nevertheless different. As for me, I would
prefer the Japanese system, for its accessibility, simplicity, and
orientation for the benefit of its population.
The United States does not have a universal healthcare system. Health
care coverage in the United States is a mixture of public and private,
as well as for-profit and nonprofit insurers. Options include fee-for-
service (FFS), preferred provider organization (PPO), point of service
(POS), health maintenance organization (HMO), Medicare, Medicaid,
and coverage from the Veterans Health Administration. A majority of
US citizens have private insurance that is often provided through their
employer, or they may buy it on their own. 12.5% of US adults are
uninsured, and countless more are underinsured. Lack of health
insurance is perhaps the greatest barrier to accessing health care
lOMoARcPSD|61746433
services and has a tremendous negative effect on an individual’s
overall health status.
The only thing close to a universal healthcare system in the United
States is the Patient Protection and Affordable Care Act ( PPACA),
which was signed into law in 2010. Its goal was to expand health
insurance coverage to Americans that were uninsured while
controlling costs and improving the quality of healthcare. Since its
beginning, it has been under scrutiny, and many parts have been
amended, including removing the penalty fee for those that did not
have health insurance. With the implementation of the PPACA,
different plan options became available for people to obtain insurance,
but private insurance is the primary health coverage for two-thirds of
Americans (67%). Over half of all private insurance is through
employers. Most employer plans cover their employees and give
various options on the level of coverage and also the option to insure
their family. Rarely an employer pays the entire premium. Most of the
time the cost is shared between the employer and employee. Only
11% of private health insurance is purchased by individuals from for-
profit and nonprofit carriers.
In America, retirees/seniors qualify for Medicare. It is a complex fee-
for-service program consisting of parts, A-D. Part A provides hospital
insurance and Part B medical insurance. Members can choose to get
their coverage just through traditional Medicare, or they can choose to
enroll in Part C which is a private health maintenance organization
(HMO) called Medicare Advantage. Part D is also optional and is for
prescription drug coverage. Medicare is financed through a
lOMoARcPSD|61746433
combination of general federal taxes, a mandatory payroll tax that
pays for Part A, and individual premiums.
The unemployed may qualify for Medicaid if their income is low. It is
a jointly sponsored state and federal program that pays for medical
services for persons who are elderly, poor, blind, or disabled, and for
certain families with dependent children who meet specified income
guidelines. Medicaid is obtained through the state of residency. The
state then received federal matching for providing the health coverage.
Veterans can receive healthcare coverage from the Veterans Health
Administration. It is America’s largest integrated healthcare system
serving 9 million enrolled Veterans each year. Having other health
insurance coverage like Medicare, Medicaid, or private insurance
doesn’t affect getting VA healthcare benefits. Each veteran’s medical
benefits package is unique. Covered benefits depend on the 'priority
group' and the advice of the VA primary provider. Retiring veterans
may also be eligible for TRICARE. It is a Medicare-wraparound
coverage for those that have Medicare Part A and B.
There are two US government-run programs available to children
from low-income households. Depending on income level, they may
qualify for Medicaid or the Children’s Health Insurance Program
(CHIP). CHIP is a state-administered public program created in 1997
for children in low-income families that earn too much to qualify for
Medicaid but are unlikely to be able to afford private insurance. CHIP
is funded through matching grants from the federal government to the
states, and most states charge a low premium and have small copays,
if any. Because it is state-administered, exactly how it works varies by
state. For example, it is considered an extension of Medicaid in some
lOMoARcPSD|61746433
states, while in others it is a separate program. Currently, 9.6 million
children are covered by this program.
Coverage of Medications
In Japan, the coverage for medication for children, the unemployed,
and the retired remain under the same rules as the coinsurance
percentages. Clinics can dispense medication directly to the patients or
they can go to the pharmacy. According to the Commonwealth Fund,
the use of pharmacies has been growing. Price revisions for
medications are also revised every 2 years. Usually, prices are lowered
for new drugs that are selling more than expected, and for brand-name
drugs when their generic counterparts become available. Prices of
generic drugs have gradually decreased. Also, if a physician
prescribes more than 6 drugs regularly to a patient, he receives a
reduced fee as a way to improve clinical decision-making.
In the US, the coverage for medication for children, the unemployed,
the and retired depends on the coverage they have.
Retired individuals with Medicare have the option to purchase private
prescription drug coverage under Medicare Part D. Part D covers most
outpatient drugs, like those that you would get a prescription for and
pick up at the pharmacy. Medicare Part B only covers very limited
outpatient prescription drug benefits, like injections that need to be
given by a medical professional. For Medicare Part D, copays and
coinsurance vary by drug plan: $0–$5 for preferred generics, up to
50% for non-preferred drugs. For the unemployed that qualify for
Medicaid, outpatient prescription drugs are an optional benefit under
federal law, however, currently, all states provide drug coverage. For
children with private health insurance, the copay for prescriptions
lOMoARcPSD|61746433
depends on that specific insurance coverage. For low-income children,
the copay for medications is reduced if part of CHIP or possibly free if
on Medicaid. Vaccines are often free to uninsured and underinsured
children.
Referral to See a Specialist
In Japan, there is no 'gatekeeper'. Children, the unemployed, and the
retired do not need to get a referral to go see a specialist. The term
'general practice' in Japan is recent, but historically, there has been no
distinction between primary care and specialty care. The fee schedule
remains the same for all providers. Patients can see a specialist
without a referral and most of the time on a walk-in basis.
A 'gatekeeper' is very common for healthcare coverage in the United
States. American children, the unemployed, and the retired are often
limited to specialty services if it is not deemed necessary or they
cannot afford the excessive fees. PPO plans often can schedule an
appointment with a specialist without permission from their primary
care provider, but those with an HMO or government-sponsored plan
do not have that option. Outpatient specialists are free to choose which
form of insurance they will accept, or whether they will accept it at
all. For example, not all specialists accept publicly insured patients,
because of the relatively lower reimbursement rates set by Medicaid
and Medicare. Access to specialists for beneficiaries of these
programs—not to mention for people without any insurance—can
therefore be particularly limited.
Coverage for Preexisting Conditions
In Japan, no one can be excluded from any coverage based on a
preexisting condition. This also became true in the United States.
lOMoARcPSD|61746433
Under current law, health insurance companies can’t refuse to cover
you or charge you more just because you have a 'pre-existing
condition', that is, a health problem you had before the date that new
health coverage starts.
Finance Implications for Healthcare Delivery
In Japan, people benefit from the universal healthcare delivery system.
All fees are determined by the government and therefore controlled.
Even though most hospitals and medical offices are privately run, they
are limited on what they can charge based on government regulations.
This allows individuals to seek medical treatment and preventative
services more often, thus leading to better health. Not only is health
benefited but a person benefits financially as well. Unlike Americans,
the Japanese do not need to worry that paying for healthcare will lead
to financial ruin. A hospital stay is in the hundreds, whereas in the
United States, it is in the thousand and can leave a person bankrupt.
Americans often go without medical treatment simply based on the
fact that they cannot afford it. Especially if they do not have health
insurance, like in the circumstance of losing a job. In Japan, if a
person loses their job their health coverage just switches from the
employer to a community plan.
The negative financial implications of Japan’s healthcare structure fall
on the providers. 50% of hospitals are in financial deficit. This is the
opposite in America, where hospitals and doctors make a profit at the
expense of the people. In America private practices can, and often do,
refuse services to those with government-sponsored insurance like
Medicaid. This is mostly due to the low reimbursement and the length
of time to receive payment. This is not allowed in Japan. There are
lOMoARcPSD|61746433
also disincentives for providers prescribing certain medications or
services because the price is then lowered upon the next government
review of fees. Again, this benefits the consumer, not the provider.
In America, both public and private insurers determine their benefit
packages and cost-sharing structures as long as it is within federal and
state regulations. Private insurers in America are for-profit, while
Japan’s statutory health insurance system (SHIS) is a not-for-profit
system. Insurers in Japan are not out to make a profit. Anything
money not used is carried over to the next year, which could lead to
premiums being reduced.
Conclusion
In summary, the comparative analysis covered in this essay has shown
that the healthcare systems of Japan and America, although they share
some common features, are nevertheless different. As for me, I would
prefer the Japanese system, for its accessibility, simplicity, and
orientation for the benefit of its population.
The United States does not have a universal healthcare system. Health
care coverage in the United States is a mixture of public and private,
as well as for-profit and nonprofit insurers. Options include fee-for-
service (FFS), preferred provider organization (PPO), point of service
(POS), health maintenance organization (HMO), Medicare, Medicaid,
and coverage from the Veterans Health Administration. A majority of
US citizens have private insurance that is often provided through their
employer, or they may buy it on their own. 12.5% of US adults are
uninsured, and countless more are underinsured. Lack of health
insurance is perhaps the greatest barrier to accessing health care
lOMoARcPSD|61746433
services and has a tremendous negative effect on an individual’s
overall health status.
The only thing close to a universal healthcare system in the United
States is the Patient Protection and Affordable Care Act ( PPACA),
which was signed into law in 2010. Its goal was to expand health
insurance coverage to Americans that were uninsured while
controlling costs and improving the quality of healthcare. Since its
beginning, it has been under scrutiny, and many parts have been
amended, including removing the penalty fee for those that did not
have health insurance. With the implementation of the PPACA,
different plan options became available for people to obtain insurance,
but private insurance is the primary health coverage for two-thirds of
Americans (67%). Over half of all private insurance is through
employers. Most employer plans cover their employees and give
various options on the level of coverage and also the option to insure
their family. Rarely an employer pays the entire premium. Most of the
time the cost is shared between the employer and employee. Only
11% of private health insurance is purchased by individuals from for-
profit and nonprofit carriers.
In America, retirees/seniors qualify for Medicare. It is a complex fee-
for-service program consisting of parts, A-D. Part A provides hospital
insurance and Part B medical insurance. Members can choose to get
their coverage just through traditional Medicare, or they can choose to
enroll in Part C which is a private health maintenance organization
(HMO) called Medicare Advantage. Part D is also optional and is for
prescription drug coverage. Medicare is financed through a
lOMoARcPSD|61746433
combination of general federal taxes, a mandatory payroll tax that
pays for Part A, and individual premiums.
The unemployed may qualify for Medicaid if their income is low. It is
a jointly sponsored state and federal program that pays for medical
services for persons who are elderly, poor, blind, or disabled, and for
certain families with dependent children who meet specified income
guidelines. Medicaid is obtained through the state of residency. The
state then received federal matching for providing the health coverage.
Veterans can receive healthcare coverage from the Veterans Health
Administration. It is America’s largest integrated healthcare system
serving 9 million enrolled Veterans each year. Having other health
insurance coverage like Medicare, Medicaid, or private insurance
doesn’t affect getting VA healthcare benefits. Each veteran’s medical
benefits package is unique. Covered benefits depend on the 'priority
group' and the advice of the VA primary provider. Retiring veterans
may also be eligible for TRICARE. It is a Medicare-wraparound
coverage for those that have Medicare Part A and B.
There are two US government-run programs available to children
from low-income households. Depending on income level, they may
qualify for Medicaid or the Children’s Health Insurance Program
(CHIP). CHIP is a state-administered public program created in 1997
for children in low-income families that earn too much to qualify for
Medicaid but are unlikely to be able to afford private insurance. CHIP
is funded through matching grants from the federal government to the
states, and most states charge a low premium and have small copays,
if any. Because it is state-administered, exactly how it works varies by
state. For example, it is considered an extension of Medicaid in some
lOMoARcPSD|61746433
states, while in others it is a separate program. Currently, 9.6 million
children are covered by this program.
Coverage of Medications
In Japan, the coverage for medication for children, the unemployed,
and the retired remain under the same rules as the coinsurance
percentages. Clinics can dispense medication directly to the patients or
they can go to the pharmacy. According to the Commonwealth Fund,
the use of pharmacies has been growing. Price revisions for
medications are also revised every 2 years. Usually, prices are lowered
for new drugs that are selling more than expected, and for brand-name
drugs when their generic counterparts become available. Prices of
generic drugs have gradually decreased. Also, if a physician
prescribes more than 6 drugs regularly to a patient, he receives a
reduced fee as a way to improve clinical decision-making.
In the US, the coverage for medication for children, the unemployed,
the and retired depends on the coverage they have.
Retired individuals with Medicare have the option to purchase private
prescription drug coverage under Medicare Part D. Part D covers most
outpatient drugs, like those that you would get a prescription for and
pick up at the pharmacy. Medicare Part B only covers very limited
outpatient prescription drug benefits, like injections that need to be
given by a medical professional. For Medicare Part D, copays and
coinsurance vary by drug plan: $0–$5 for preferred generics, up to
50% for non-preferred drugs. For the unemployed that qualify for
Medicaid, outpatient prescription drugs are an optional benefit under
federal law, however, currently, all states provide drug coverage. For
children with private health insurance, the copay for prescriptions
lOMoARcPSD|61746433
depends on that specific insurance coverage. For low-income children,
the copay for medications is reduced if part of CHIP or possibly free if
on Medicaid. Vaccines are often free to uninsured and underinsured
children.
Referral to See a Specialist
In Japan, there is no 'gatekeeper'. Children, the unemployed, and the
retired do not need to get a referral to go see a specialist. The term
'general practice' in Japan is recent, but historically, there has been no
distinction between primary care and specialty care. The fee schedule
remains the same for all providers. Patients can see a specialist
without a referral and most of the time on a walk-in basis.
A 'gatekeeper' is very common for healthcare coverage in the United
States. American children, the unemployed, and the retired are often
limited to specialty services if it is not deemed necessary or they
cannot afford the excessive fees. PPO plans often can schedule an
appointment with a specialist without permission from their primary
care provider, but those with an HMO or government-sponsored plan
do not have that option. Outpatient specialists are free to choose which
form of insurance they will accept, or whether they will accept it at
all. For example, not all specialists accept publicly insured patients,
because of the relatively lower reimbursement rates set by Medicaid
and Medicare. Access to specialists for beneficiaries of these
programs—not to mention for people without any insurance—can
therefore be particularly limited.
Coverage for Preexisting Conditions
In Japan, no one can be excluded from any coverage based on a
preexisting condition. This also became true in the United States.
lOMoARcPSD|61746433
Under current law, health insurance companies can’t refuse to cover
you or charge you more just because you have a 'pre-existing
condition', that is, a health problem you had before the date that new
health coverage starts.
Finance Implications for Healthcare Delivery
In Japan, people benefit from the universal healthcare delivery system.
All fees are determined by the government and therefore controlled.
Even though most hospitals and medical offices are privately run, they
are limited on what they can charge based on government regulations.
This allows individuals to seek medical treatment and preventative
services more often, thus leading to better health. Not only is health
benefited but a person benefits financially as well. Unlike Americans,
the Japanese do not need to worry that paying for healthcare will lead
to financial ruin. A hospital stay is in the hundreds, whereas in the
United States, it is in the thousand and can leave a person bankrupt.
Americans often go without medical treatment simply based on the
fact that they cannot afford it. Especially if they do not have health
insurance, like in the circumstance of losing a job. In Japan, if a
person loses their job their health coverage just switches from the
employer to a community plan.
The negative financial implications of Japan’s healthcare structure fall
on the providers. 50% of hospitals are in financial deficit. This is the
opposite in America, where hospitals and doctors make a profit at the
expense of the people. In America private practices can, and often do,
refuse services to those with government-sponsored insurance like
Medicaid. This is mostly due to the low reimbursement and the length
of time to receive payment. This is not allowed in Japan. There are
lOMoARcPSD|61746433
also disincentives for providers prescribing certain medications or
services because the price is then lowered upon the next government
review of fees. Again, this benefits the consumer, not the provider.
In America, both public and private insurers determine their benefit
packages and cost-sharing structures as long as it is within federal and
state regulations. Private insurers in America are for-profit, while
Japan’s statutory health insurance system (SHIS) is a not-for-profit
system. Insurers in Japan are not out to make a profit. Anything
money not used is carried over to the next year, which could lead to
premiums being reduced.
Conclusion
In summary, the comparative analysis covered in this essay has shown
that the healthcare systems of Japan and America, although they share
some common features, are nevertheless different. As for me, I would
prefer the Japanese system, for its accessibility, simplicity, and
orientation for the benefit of its population.
The United States does not have a universal healthcare system. Health
care coverage in the United States is a mixture of public and private,
as well as for-profit and nonprofit insurers. Options include fee-for-
service (FFS), preferred provider organization (PPO), point of service
(POS), health maintenance organization (HMO), Medicare, Medicaid,
and coverage from the Veterans Health Administration. A majority of
US citizens have private insurance that is often provided through their
employer, or they may buy it on their own. 12.5% of US adults are
uninsured, and countless more are underinsured. Lack of health
insurance is perhaps the greatest barrier to accessing health care
lOMoARcPSD|61746433
services and has a tremendous negative effect on an individual’s
overall health status.
The only thing close to a universal healthcare system in the United
States is the Patient Protection and Affordable Care Act ( PPACA),
which was signed into law in 2010. Its goal was to expand health
insurance coverage to Americans that were uninsured while
controlling costs and improving the quality of healthcare. Since its
beginning, it has been under scrutiny, and many parts have been
amended, including removing the penalty fee for those that did not
have health insurance. With the implementation of the PPACA,
different plan options became available for people to obtain insurance,
but private insurance is the primary health coverage for two-thirds of
Americans (67%). Over half of all private insurance is through
employers. Most employer plans cover their employees and give
various options on the level of coverage and also the option to insure
their family. Rarely an employer pays the entire premium. Most of the
time the cost is shared between the employer and employee. Only
11% of private health insurance is purchased by individuals from for-
profit and nonprofit carriers.
In America, retirees/seniors qualify for Medicare. It is a complex fee-
for-service program consisting of parts, A-D. Part A provides hospital
insurance and Part B medical insurance. Members can choose to get
their coverage just through traditional Medicare, or they can choose to
enroll in Part C which is a private health maintenance organization
(HMO) called Medicare Advantage. Part D is also optional and is for
prescription drug coverage. Medicare is financed through a
lOMoARcPSD|61746433
combination of general federal taxes, a mandatory payroll tax that
pays for Part A, and individual premiums.
The unemployed may qualify for Medicaid if their income is low. It is
a jointly sponsored state and federal program that pays for medical
services for persons who are elderly, poor, blind, or disabled, and for
certain families with dependent children who meet specified income
guidelines. Medicaid is obtained through the state of residency. The
state then received federal matching for providing the health coverage.
Veterans can receive healthcare coverage from the Veterans Health
Administration. It is America’s largest integrated healthcare system
serving 9 million enrolled Veterans each year. Having other health
insurance coverage like Medicare, Medicaid, or private insurance
doesn’t affect getting VA healthcare benefits. Each veteran’s medical
benefits package is unique. Covered benefits depend on the 'priority
group' and the advice of the VA primary provider. Retiring veterans
may also be eligible for TRICARE. It is a Medicare-wraparound
coverage for those that have Medicare Part A and B.
There are two US government-run programs available to children
from low-income households. Depending on income level, they may
qualify for Medicaid or the Children’s Health Insurance Program
(CHIP). CHIP is a state-administered public program created in 1997
for children in low-income families that earn too much to qualify for
Medicaid but are unlikely to be able to afford private insurance. CHIP
is funded through matching grants from the federal government to the
states, and most states charge a low premium and have small copays,
if any. Because it is state-administered, exactly how it works varies by
state. For example, it is considered an extension of Medicaid in some
lOMoARcPSD|61746433
states, while in others it is a separate program. Currently, 9.6 million
children are covered by this program.
Coverage of Medications
In Japan, the coverage for medication for children, the unemployed,
and the retired remain under the same rules as the coinsurance
percentages. Clinics can dispense medication directly to the patients or
they can go to the pharmacy. According to the Commonwealth Fund,
the use of pharmacies has been growing. Price revisions for
medications are also revised every 2 years. Usually, prices are lowered
for new drugs that are selling more than expected, and for brand-name
drugs when their generic counterparts become available. Prices of
generic drugs have gradually decreased. Also, if a physician
prescribes more than 6 drugs regularly to a patient, he receives a
reduced fee as a way to improve clinical decision-making.
In the US, the coverage for medication for children, the unemployed,
the and retired depends on the coverage they have.
Retired individuals with Medicare have the option to purchase private
prescription drug coverage under Medicare Part D. Part D covers most
outpatient drugs, like those that you would get a prescription for and
pick up at the pharmacy. Medicare Part B only covers very limited
outpatient prescription drug benefits, like injections that need to be
given by a medical professional. For Medicare Part D, copays and
coinsurance vary by drug plan: $0–$5 for preferred generics, up to
50% for non-preferred drugs. For the unemployed that qualify for
Medicaid, outpatient prescription drugs are an optional benefit under
federal law, however, currently, all states provide drug coverage. For
children with private health insurance, the copay for prescriptions
lOMoARcPSD|61746433
depends on that specific insurance coverage. For low-income children,
the copay for medications is reduced if part of CHIP or possibly free if
on Medicaid. Vaccines are often free to uninsured and underinsured
children.
Referral to See a Specialist
In Japan, there is no 'gatekeeper'. Children, the unemployed, and the
retired do not need to get a referral to go see a specialist. The term
'general practice' in Japan is recent, but historically, there has been no
distinction between primary care and specialty care. The fee schedule
remains the same for all providers. Patients can see a specialist
without a referral and most of the time on a walk-in basis.
A 'gatekeeper' is very common for healthcare coverage in the United
States. American children, the unemployed, and the retired are often
limited to specialty services if it is not deemed necessary or they
cannot afford the excessive fees. PPO plans often can schedule an
appointment with a specialist without permission from their primary
care provider, but those with an HMO or government-sponsored plan
do not have that option. Outpatient specialists are free to choose which
form of insurance they will accept, or whether they will accept it at
all. For example, not all specialists accept publicly insured patients,
because of the relatively lower reimbursement rates set by Medicaid
and Medicare. Access to specialists for beneficiaries of these
programs—not to mention for people without any insurance—can
therefore be particularly limited.
Coverage for Preexisting Conditions
In Japan, no one can be excluded from any coverage based on a
preexisting condition. This also became true in the United States.
lOMoARcPSD|61746433
Under current law, health insurance companies can’t refuse to cover
you or charge you more just because you have a 'pre-existing
condition', that is, a health problem you had before the date that new
health coverage starts.
Finance Implications for Healthcare Delivery
In Japan, people benefit from the universal healthcare delivery system.
All fees are determined by the government and therefore controlled.
Even though most hospitals and medical offices are privately run, they
are limited on what they can charge based on government regulations.
This allows individuals to seek medical treatment and preventative
services more often, thus leading to better health. Not only is health
benefited but a person benefits financially as well. Unlike Americans,
the Japanese do not need to worry that paying for healthcare will lead
to financial ruin. A hospital stay is in the hundreds, whereas in the
United States, it is in the thousand and can leave a person bankrupt.
Americans often go without medical treatment simply based on the
fact that they cannot afford it. Especially if they do not have health
insurance, like in the circumstance of losing a job. In Japan, if a
person loses their job their health coverage just switches from the
employer to a community plan.
The negative financial implications of Japan’s healthcare structure fall
on the providers. 50% of hospitals are in financial deficit. This is the
opposite in America, where hospitals and doctors make a profit at the
expense of the people. In America private practices can, and often do,
refuse services to those with government-sponsored insurance like
Medicaid. This is mostly due to the low reimbursement and the length
of time to receive payment. This is not allowed in Japan. There are
lOMoARcPSD|61746433
also disincentives for providers prescribing certain medications or
services because the price is then lowered upon the next government
review of fees. Again, this benefits the consumer, not the provider.
In America, both public and private insurers determine their benefit
packages and cost-sharing structures as long as it is within federal and
state regulations. Private insurers in America are for-profit, while
Japan’s statutory health insurance system (SHIS) is a not-for-profit
system. Insurers in Japan are not out to make a profit. Anything
money not used is carried over to the next year, which could lead to
premiums being reduced.
Conclusion
In summary, the comparative analysis covered in this essay has shown
that the healthcare systems of Japan and America, although they share
some common features, are nevertheless different. As for me, I would
prefer the Japanese system, for its accessibility, simplicity, and
orientation for the benefit of its population.
The United States does not have a universal healthcare system. Health
care coverage in the United States is a mixture of public and private,
as well as for-profit and nonprofit insurers. Options include fee-for-
service (FFS), preferred provider organization (PPO), point of service
(POS), health maintenance organization (HMO), Medicare, Medicaid,
and coverage from the Veterans Health Administration. A majority of
US citizens have private insurance that is often provided through their
employer, or they may buy it on their own. 12.5% of US adults are
uninsured, and countless more are underinsured. Lack of health
insurance is perhaps the greatest barrier to accessing health care
lOMoARcPSD|61746433
services and has a tremendous negative effect on an individual’s
overall health status.
The only thing close to a universal healthcare system in the United
States is the Patient Protection and Affordable Care Act ( PPACA),
which was signed into law in 2010. Its goal was to expand health
insurance coverage to Americans that were uninsured while
controlling costs and improving the quality of healthcare. Since its
beginning, it has been under scrutiny, and many parts have been
amended, including removing the penalty fee for those that did not
have health insurance. With the implementation of the PPACA,
different plan options became available for people to obtain insurance,
but private insurance is the primary health coverage for two-thirds of
Americans (67%). Over half of all private insurance is through
employers. Most employer plans cover their employees and give
various options on the level of coverage and also the option to insure
their family. Rarely an employer pays the entire premium. Most of the
time the cost is shared between the employer and employee. Only
11% of private health insurance is purchased by individuals from for-
profit and nonprofit carriers.
In America, retirees/seniors qualify for Medicare. It is a complex fee-
for-service program consisting of parts, A-D. Part A provides hospital
insurance and Part B medical insurance. Members can choose to get
their coverage just through traditional Medicare, or they can choose to
enroll in Part C which is a private health maintenance organization
(HMO) called Medicare Advantage. Part D is also optional and is for
prescription drug coverage. Medicare is financed through a
lOMoARcPSD|61746433
combination of general federal taxes, a mandatory payroll tax that
pays for Part A, and individual premiums.
The unemployed may qualify for Medicaid if their income is low. It is
a jointly sponsored state and federal program that pays for medical
services for persons who are elderly, poor, blind, or disabled, and for
certain families with dependent children who meet specified income
guidelines. Medicaid is obtained through the state of residency. The
state then received federal matching for providing the health coverage.
Veterans can receive healthcare coverage from the Veterans Health
Administration. It is America’s largest integrated healthcare system
serving 9 million enrolled Veterans each year. Having other health
insurance coverage like Medicare, Medicaid, or private insurance
doesn’t affect getting VA healthcare benefits. Each veteran’s medical
benefits package is unique. Covered benefits depend on the 'priority
group' and the advice of the VA primary provider. Retiring veterans
may also be eligible for TRICARE. It is a Medicare-wraparound
coverage for those that have Medicare Part A and B.
There are two US government-run programs available to children
from low-income households. Depending on income level, they may
qualify for Medicaid or the Children’s Health Insurance Program
(CHIP). CHIP is a state-administered public program created in 1997
for children in low-income families that earn too much to qualify for
Medicaid but are unlikely to be able to afford private insurance. CHIP
is funded through matching grants from the federal government to the
states, and most states charge a low premium and have small copays,
if any. Because it is state-administered, exactly how it works varies by
state. For example, it is considered an extension of Medicaid in some
lOMoARcPSD|61746433
states, while in others it is a separate program. Currently, 9.6 million
children are covered by this program.
Coverage of Medications
In Japan, the coverage for medication for children, the unemployed,
and the retired remain under the same rules as the coinsurance
percentages. Clinics can dispense medication directly to the patients or
they can go to the pharmacy. According to the Commonwealth Fund,
the use of pharmacies has been growing. Price revisions for
medications are also revised every 2 years. Usually, prices are lowered
for new drugs that are selling more than expected, and for brand-name
drugs when their generic counterparts become available. Prices of
generic drugs have gradually decreased. Also, if a physician
prescribes more than 6 drugs regularly to a patient, he receives a
reduced fee as a way to improve clinical decision-making.
In the US, the coverage for medication for children, the unemployed,
the and retired depends on the coverage they have.
Retired individuals with Medicare have the option to purchase private
prescription drug coverage under Medicare Part D. Part D covers most
outpatient drugs, like those that you would get a prescription for and
pick up at the pharmacy. Medicare Part B only covers very limited
outpatient prescription drug benefits, like injections that need to be
given by a medical professional. For Medicare Part D, copays and
coinsurance vary by drug plan: $0–$5 for preferred generics, up to
50% for non-preferred drugs. For the unemployed that qualify for
Medicaid, outpatient prescription drugs are an optional benefit under
federal law, however, currently, all states provide drug coverage. For
children with private health insurance, the copay for prescriptions
lOMoARcPSD|61746433
depends on that specific insurance coverage. For low-income children,
the copay for medications is reduced if part of CHIP or possibly free if
on Medicaid. Vaccines are often free to uninsured and underinsured
children.
Referral to See a Specialist
In Japan, there is no 'gatekeeper'. Children, the unemployed, and the
retired do not need to get a referral to go see a specialist. The term
'general practice' in Japan is recent, but historically, there has been no
distinction between primary care and specialty care. The fee schedule
remains the same for all providers. Patients can see a specialist
without a referral and most of the time on a walk-in basis.
A 'gatekeeper' is very common for healthcare coverage in the United
States. American children, the unemployed, and the retired are often
limited to specialty services if it is not deemed necessary or they
cannot afford the excessive fees. PPO plans often can schedule an
appointment with a specialist without permission from their primary
care provider, but those with an HMO or government-sponsored plan
do not have that option. Outpatient specialists are free to choose which
form of insurance they will accept, or whether they will accept it at
all. For example, not all specialists accept publicly insured patients,
because of the relatively lower reimbursement rates set by Medicaid
and Medicare. Access to specialists for beneficiaries of these
programs—not to mention for people without any insurance—can
therefore be particularly limited.
Coverage for Preexisting Conditions
In Japan, no one can be excluded from any coverage based on a
preexisting condition. This also became true in the United States.
lOMoARcPSD|61746433
Under current law, health insurance companies can’t refuse to cover
you or charge you more just because you have a 'pre-existing
condition', that is, a health problem you had before the date that new
health coverage starts.
Finance Implications for Healthcare Delivery
In Japan, people benefit from the universal healthcare delivery system.
All fees are determined by the government and therefore controlled.
Even though most hospitals and medical offices are privately run, they
are limited on what they can charge based on government regulations.
This allows individuals to seek medical treatment and preventative
services more often, thus leading to better health. Not only is health
benefited but a person benefits financially as well. Unlike Americans,
the Japanese do not need to worry that paying for healthcare will lead
to financial ruin. A hospital stay is in the hundreds, whereas in the
United States, it is in the thousand and can leave a person bankrupt.
Americans often go without medical treatment simply based on the
fact that they cannot afford it. Especially if they do not have health
insurance, like in the circumstance of losing a job. In Japan, if a
person loses their job their health coverage just switches from the
employer to a community plan.
The negative financial implications of Japan’s healthcare structure fall
on the providers. 50% of hospitals are in financial deficit. This is the
opposite in America, where hospitals and doctors make a profit at the
expense of the people. In America private practices can, and often do,
refuse services to those with government-sponsored insurance like
Medicaid. This is mostly due to the low reimbursement and the length
of time to receive payment. This is not allowed in Japan. There are
lOMoARcPSD|61746433
also disincentives for providers prescribing certain medications or
services because the price is then lowered upon the next government
review of fees. Again, this benefits the consumer, not the provider.
In America, both public and private insurers determine their benefit
packages and cost-sharing structures as long as it is within federal and
state regulations. Private insurers in America are for-profit, while
Japan’s statutory health insurance system (SHIS) is a not-for-profit
system. Insurers in Japan are not out to make a profit. Anything
money not used is carried over to the next year, which could lead to
premiums being reduced.
Conclusion
In summary, the comparative analysis covered in this essay has shown
that the healthcare systems of Japan and America, although they share
some common features, are nevertheless different. As for me, I would
prefer the Japanese system, for its accessibility, simplicity, and
orientation for the benefit of its population.
The United States does not have a universal healthcare system. Health
care coverage in the United States is a mixture of public and private,
as well as for-profit and nonprofit insurers. Options include fee-for-
service (FFS), preferred provider organization (PPO), point of service
(POS), health maintenance organization (HMO), Medicare, Medicaid,
and coverage from the Veterans Health Administration. A majority of
US citizens have private insurance that is often provided through their
employer, or they may buy it on their own. 12.5% of US adults are
uninsured, and countless more are underinsured. Lack of health
insurance is perhaps the greatest barrier to accessing health care
lOMoARcPSD|61746433
services and has a tremendous negative effect on an individual’s
overall health status.
The only thing close to a universal healthcare system in the United
States is the Patient Protection and Affordable Care Act ( PPACA),
which was signed into law in 2010. Its goal was to expand health
insurance coverage to Americans that were uninsured while
controlling costs and improving the quality of healthcare. Since its
beginning, it has been under scrutiny, and many parts have been
amended, including removing the penalty fee for those that did not
have health insurance. With the implementation of the PPACA,
different plan options became available for people to obtain insurance,
but private insurance is the primary health coverage for two-thirds of
Americans (67%). Over half of all private insurance is through
employers. Most employer plans cover their employees and give
various options on the level of coverage and also the option to insure
their family. Rarely an employer pays the entire premium. Most of the
time the cost is shared between the employer and employee. Only
11% of private health insurance is purchased by individuals from for-
profit and nonprofit carriers.
In America, retirees/seniors qualify for Medicare. It is a complex fee-
for-service program consisting of parts, A-D. Part A provides hospital
insurance and Part B medical insurance. Members can choose to get
their coverage just through traditional Medicare, or they can choose to
enroll in Part C which is a private health maintenance organization
(HMO) called Medicare Advantage. Part D is also optional and is for
prescription drug coverage. Medicare is financed through a
lOMoARcPSD|61746433
combination of general federal taxes, a mandatory payroll tax that
pays for Part A, and individual premiums.
The unemployed may qualify for Medicaid if their income is low. It is
a jointly sponsored state and federal program that pays for medical
services for persons who are elderly, poor, blind, or disabled, and for
certain families with dependent children who meet specified income
guidelines. Medicaid is obtained through the state of residency. The
state then received federal matching for providing the health coverage.
Veterans can receive healthcare coverage from the Veterans Health
Administration. It is America’s largest integrated healthcare system
serving 9 million enrolled Veterans each year. Having other health
insurance coverage like Medicare, Medicaid, or private insurance
doesn’t affect getting VA healthcare benefits. Each veteran’s medical
benefits package is unique. Covered benefits depend on the 'priority
group' and the advice of the VA primary provider. Retiring veterans
may also be eligible for TRICARE. It is a Medicare-wraparound
coverage for those that have Medicare Part A and B.
There are two US government-run programs available to children
from low-income households. Depending on income level, they may
qualify for Medicaid or the Children’s Health Insurance Program
(CHIP). CHIP is a state-administered public program created in 1997
for children in low-income families that earn too much to qualify for
Medicaid but are unlikely to be able to afford private insurance. CHIP
is funded through matching grants from the federal government to the
states, and most states charge a low premium and have small copays,
if any. Because it is state-administered, exactly how it works varies by
state. For example, it is considered an extension of Medicaid in some
lOMoARcPSD|61746433
states, while in others it is a separate program. Currently, 9.6 million
children are covered by this program.
Coverage of Medications
In Japan, the coverage for medication for children, the unemployed,
and the retired remain under the same rules as the coinsurance
percentages. Clinics can dispense medication directly to the patients or
they can go to the pharmacy. According to the Commonwealth Fund,
the use of pharmacies has been growing. Price revisions for
medications are also revised every 2 years. Usually, prices are lowered
for new drugs that are selling more than expected, and for brand-name
drugs when their generic counterparts become available. Prices of
generic drugs have gradually decreased. Also, if a physician
prescribes more than 6 drugs regularly to a patient, he receives a
reduced fee as a way to improve clinical decision-making.
In the US, the coverage for medication for children, the unemployed,
the and retired depends on the coverage they have.
Retired individuals with Medicare have the option to purchase private
prescription drug coverage under Medicare Part D. Part D covers most
outpatient drugs, like those that you would get a prescription for and
pick up at the pharmacy. Medicare Part B only covers very limited
outpatient prescription drug benefits, like injections that need to be
given by a medical professional. For Medicare Part D, copays and
coinsurance vary by drug plan: $0–$5 for preferred generics, up to
50% for non-preferred drugs. For the unemployed that qualify for
Medicaid, outpatient prescription drugs are an optional benefit under
federal law, however, currently, all states provide drug coverage. For
children with private health insurance, the copay for prescriptions
lOMoARcPSD|61746433
depends on that specific insurance coverage. For low-income children,
the copay for medications is reduced if part of CHIP or possibly free if
on Medicaid. Vaccines are often free to uninsured and underinsured
children.
Referral to See a Specialist
In Japan, there is no 'gatekeeper'. Children, the unemployed, and the
retired do not need to get a referral to go see a specialist. The term
'general practice' in Japan is recent, but historically, there has been no
distinction between primary care and specialty care. The fee schedule
remains the same for all providers. Patients can see a specialist
without a referral and most of the time on a walk-in basis.
A 'gatekeeper' is very common for healthcare coverage in the United
States. American children, the unemployed, and the retired are often
limited to specialty services if it is not deemed necessary or they
cannot afford the excessive fees. PPO plans often can schedule an
appointment with a specialist without permission from their primary
care provider, but those with an HMO or government-sponsored plan
do not have that option. Outpatient specialists are free to choose which
form of insurance they will accept, or whether they will accept it at
all. For example, not all specialists accept publicly insured patients,
because of the relatively lower reimbursement rates set by Medicaid
and Medicare. Access to specialists for beneficiaries of these
programs—not to mention for people without any insurance—can
therefore be particularly limited.
Coverage for Preexisting Conditions
In Japan, no one can be excluded from any coverage based on a
preexisting condition. This also became true in the United States.
lOMoARcPSD|61746433
Under current law, health insurance companies can’t refuse to cover
you or charge you more just because you have a 'pre-existing
condition', that is, a health problem you had before the date that new
health coverage starts.
Finance Implications for Healthcare Delivery
In Japan, people benefit from the universal healthcare delivery system.
All fees are determined by the government and therefore controlled.
Even though most hospitals and medical offices are privately run, they
are limited on what they can charge based on government regulations.
This allows individuals to seek medical treatment and preventative
services more often, thus leading to better health. Not only is health
benefited but a person benefits financially as well. Unlike Americans,
the Japanese do not need to worry that paying for healthcare will lead
to financial ruin. A hospital stay is in the hundreds, whereas in the
United States, it is in the thousand and can leave a person bankrupt.
Americans often go without medical treatment simply based on the
fact that they cannot afford it. Especially if they do not have health
insurance, like in the circumstance of losing a job. In Japan, if a
person loses their job their health coverage just switches from the
employer to a community plan.
The negative financial implications of Japan’s healthcare structure fall
on the providers. 50% of hospitals are in financial deficit. This is the
opposite in America, where hospitals and doctors make a profit at the
expense of the people. In America private practices can, and often do,
refuse services to those with government-sponsored insurance like
Medicaid. This is mostly due to the low reimbursement and the length
of time to receive payment. This is not allowed in Japan. There are
lOMoARcPSD|61746433
also disincentives for providers prescribing certain medications or
services because the price is then lowered upon the next government
review of fees. Again, this benefits the consumer, not the provider.
In America, both public and private insurers determine their benefit
packages and cost-sharing structures as long as it is within federal and
state regulations. Private insurers in America are for-profit, while
Japan’s statutory health insurance system (SHIS) is a not-for-profit
system. Insurers in Japan are not out to make a profit. Anything
money not used is carried over to the next year, which could lead to
premiums being reduced.
Conclusion
In summary, the comparative analysis covered in this essay has shown
that the healthcare systems of Japan and America, although they share
some common features, are nevertheless different. As for me, I would
prefer the Japanese system, for its accessibility, simplicity, and
orientation for the benefit of its population.
The United States does not have a universal healthcare system. Health
care coverage in the United States is a mixture of public and private,
as well as for-profit and nonprofit insurers. Options include fee-for-
service (FFS), preferred provider organization (PPO), point of service
(POS), health maintenance organization (HMO), Medicare, Medicaid,
and coverage from the Veterans Health Administration. A majority of
US citizens have private insurance that is often provided through their
employer, or they may buy it on their own. 12.5% of US adults are
uninsured, and countless more are underinsured. Lack of health
insurance is perhaps the greatest barrier to accessing health care
lOMoARcPSD|61746433
services and has a tremendous negative effect on an individual’s
overall health status.
The only thing close to a universal healthcare system in the United
States is the Patient Protection and Affordable Care Act ( PPACA),
which was signed into law in 2010. Its goal was to expand health
insurance coverage to Americans that were uninsured while
controlling costs and improving the quality of healthcare. Since its
beginning, it has been under scrutiny, and many parts have been
amended, including removing the penalty fee for those that did not
have health insurance. With the implementation of the PPACA,
different plan options became available for people to obtain insurance,
but private insurance is the primary health coverage for two-thirds of
Americans (67%). Over half of all private insurance is through
employers. Most employer plans cover their employees and give
various options on the level of coverage and also the option to insure
their family. Rarely an employer pays the entire premium. Most of the
time the cost is shared between the employer and employee. Only
11% of private health insurance is purchased by individuals from for-
profit and nonprofit carriers.
In America, retirees/seniors qualify for Medicare. It is a complex fee-
for-service program consisting of parts, A-D. Part A provides hospital
insurance and Part B medical insurance. Members can choose to get
their coverage just through traditional Medicare, or they can choose to
enroll in Part C which is a private health maintenance organization
(HMO) called Medicare Advantage. Part D is also optional and is for
prescription drug coverage. Medicare is financed through a
lOMoARcPSD|61746433
combination of general federal taxes, a mandatory payroll tax that
pays for Part A, and individual premiums.
The unemployed may qualify for Medicaid if their income is low. It is
a jointly sponsored state and federal program that pays for medical
services for persons who are elderly, poor, blind, or disabled, and for
certain families with dependent children who meet specified income
guidelines. Medicaid is obtained through the state of residency. The
state then received federal matching for providing the health coverage.
Veterans can receive healthcare coverage from the Veterans Health
Administration. It is America’s largest integrated healthcare system
serving 9 million enrolled Veterans each year. Having other health
insurance coverage like Medicare, Medicaid, or private insurance
doesn’t affect getting VA healthcare benefits. Each veteran’s medical
benefits package is unique. Covered benefits depend on the 'priority
group' and the advice of the VA primary provider. Retiring veterans
may also be eligible for TRICARE. It is a Medicare-wraparound
coverage for those that have Medicare Part A and B.
There are two US government-run programs available to children
from low-income households. Depending on income level, they may
qualify for Medicaid or the Children’s Health Insurance Program
(CHIP). CHIP is a state-administered public program created in 1997
for children in low-income families that earn too much to qualify for
Medicaid but are unlikely to be able to afford private insurance. CHIP
is funded through matching grants from the federal government to the
states, and most states charge a low premium and have small copays,
if any. Because it is state-administered, exactly how it works varies by
state. For example, it is considered an extension of Medicaid in some
lOMoARcPSD|61746433
states, while in others it is a separate program. Currently, 9.6 million
children are covered by this program.
Coverage of Medications
In Japan, the coverage for medication for children, the unemployed,
and the retired remain under the same rules as the coinsurance
percentages. Clinics can dispense medication directly to the patients or
they can go to the pharmacy. According to the Commonwealth Fund,
the use of pharmacies has been growing. Price revisions for
medications are also revised every 2 years. Usually, prices are lowered
for new drugs that are selling more than expected, and for brand-name
drugs when their generic counterparts become available. Prices of
generic drugs have gradually decreased. Also, if a physician
prescribes more than 6 drugs regularly to a patient, he receives a
reduced fee as a way to improve clinical decision-making.
In the US, the coverage for medication for children, the unemployed,
the and retired depends on the coverage they have.
Retired individuals with Medicare have the option to purchase private
prescription drug coverage under Medicare Part D. Part D covers most
outpatient drugs, like those that you would get a prescription for and
pick up at the pharmacy. Medicare Part B only covers very limited
outpatient prescription drug benefits, like injections that need to be
given by a medical professional. For Medicare Part D, copays and
coinsurance vary by drug plan: $0–$5 for preferred generics, up to
50% for non-preferred drugs. For the unemployed that qualify for
Medicaid, outpatient prescription drugs are an optional benefit under
federal law, however, currently, all states provide drug coverage. For
children with private health insurance, the copay for prescriptions
lOMoARcPSD|61746433
depends on that specific insurance coverage. For low-income children,
the copay for medications is reduced if part of CHIP or possibly free if
on Medicaid. Vaccines are often free to uninsured and underinsured
children.
Referral to See a Specialist
In Japan, there is no 'gatekeeper'. Children, the unemployed, and the
retired do not need to get a referral to go see a specialist. The term
'general practice' in Japan is recent, but historically, there has been no
distinction between primary care and specialty care. The fee schedule
remains the same for all providers. Patients can see a specialist
without a referral and most of the time on a walk-in basis.
A 'gatekeeper' is very common for healthcare coverage in the United
States. American children, the unemployed, and the retired are often
limited to specialty services if it is not deemed necessary or they
cannot afford the excessive fees. PPO plans often can schedule an
appointment with a specialist without permission from their primary
care provider, but those with an HMO or government-sponsored plan
do not have that option. Outpatient specialists are free to choose which
form of insurance they will accept, or whether they will accept it at
all. For example, not all specialists accept publicly insured patients,
because of the relatively lower reimbursement rates set by Medicaid
and Medicare. Access to specialists for beneficiaries of these
programs—not to mention for people without any insurance—can
therefore be particularly limited.
Coverage for Preexisting Conditions
In Japan, no one can be excluded from any coverage based on a
preexisting condition. This also became true in the United States.
lOMoARcPSD|61746433
Under current law, health insurance companies can’t refuse to cover
you or charge you more just because you have a 'pre-existing
condition', that is, a health problem you had before the date that new
health coverage starts.
Finance Implications for Healthcare Delivery
In Japan, people benefit from the universal healthcare delivery system.
All fees are determined by the government and therefore controlled.
Even though most hospitals and medical offices are privately run, they
are limited on what they can charge based on government regulations.
This allows individuals to seek medical treatment and preventative
services more often, thus leading to better health. Not only is health
benefited but a person benefits financially as well. Unlike Americans,
the Japanese do not need to worry that paying for healthcare will lead
to financial ruin. A hospital stay is in the hundreds, whereas in the
United States, it is in the thousand and can leave a person bankrupt.
Americans often go without medical treatment simply based on the
fact that they cannot afford it. Especially if they do not have health
insurance, like in the circumstance of losing a job. In Japan, if a
person loses their job their health coverage just switches from the
employer to a community plan.
The negative financial implications of Japan’s healthcare structure fall
on the providers. 50% of hospitals are in financial deficit. This is the
opposite in America, where hospitals and doctors make a profit at the
expense of the people. In America private practices can, and often do,
refuse services to those with government-sponsored insurance like
Medicaid. This is mostly due to the low reimbursement and the length
of time to receive payment. This is not allowed in Japan. There are
lOMoARcPSD|61746433
also disincentives for providers prescribing certain medications or
services because the price is then lowered upon the next government
review of fees. Again, this benefits the consumer, not the provider.
In America, both public and private insurers determine their benefit
packages and cost-sharing structures as long as it is within federal and
state regulations. Private insurers in America are for-profit, while
Japan’s statutory health insurance system (SHIS) is a not-for-profit
system. Insurers in Japan are not out to make a profit. Anything
money not used is carried over to the next year, which could lead to
premiums being reduced.
Conclusion
In summary, the comparative analysis covered in this essay has shown
that the healthcare systems of Japan and America, although they share
some common features, are nevertheless different. As for me, I would
prefer the Japanese system, for its accessibility, simplicity, and
orientation for the benefit of its population.
The United States does not have a universal healthcare system. Health
care coverage in the United States is a mixture of public and private,
as well as for-profit and nonprofit insurers. Options include fee-for-
service (FFS), preferred provider organization (PPO), point of service
(POS), health maintenance organization (HMO), Medicare, Medicaid,
and coverage from the Veterans Health Administration. A majority of
US citizens have private insurance that is often provided through their
employer, or they may buy it on their own. 12.5% of US adults are
uninsured, and countless more are underinsured. Lack of health
insurance is perhaps the greatest barrier to accessing health care
lOMoARcPSD|61746433
services and has a tremendous negative effect on an individual’s
overall health status.
The only thing close to a universal healthcare system in the United
States is the Patient Protection and Affordable Care Act ( PPACA),
which was signed into law in 2010. Its goal was to expand health
insurance coverage to Americans that were uninsured while
controlling costs and improving the quality of healthcare. Since its
beginning, it has been under scrutiny, and many parts have been
amended, including removing the penalty fee for those that did not
have health insurance. With the implementation of the PPACA,
different plan options became available for people to obtain insurance,
but private insurance is the primary health coverage for two-thirds of
Americans (67%). Over half of all private insurance is through
employers. Most employer plans cover their employees and give
various options on the level of coverage and also the option to insure
their family. Rarely an employer pays the entire premium. Most of the
time the cost is shared between the employer and employee. Only
11% of private health insurance is purchased by individuals from for-
profit and nonprofit carriers.
In America, retirees/seniors qualify for Medicare. It is a complex fee-
for-service program consisting of parts, A-D. Part A provides hospital
insurance and Part B medical insurance. Members can choose to get
their coverage just through traditional Medicare, or they can choose to
enroll in Part C which is a private health maintenance organization
(HMO) called Medicare Advantage. Part D is also optional and is for
prescription drug coverage. Medicare is financed through a
lOMoARcPSD|61746433
combination of general federal taxes, a mandatory payroll tax that
pays for Part A, and individual premiums.
The unemployed may qualify for Medicaid if their income is low. It is
a jointly sponsored state and federal program that pays for medical
services for persons who are elderly, poor, blind, or disabled, and for
certain families with dependent children who meet specified income
guidelines. Medicaid is obtained through the state of residency. The
state then received federal matching for providing the health coverage.
Veterans can receive healthcare coverage from the Veterans Health
Administration. It is America’s largest integrated healthcare system
serving 9 million enrolled Veterans each year. Having other health
insurance coverage like Medicare, Medicaid, or private insurance
doesn’t affect getting VA healthcare benefits. Each veteran’s medical
benefits package is unique. Covered benefits depend on the 'priority
group' and the advice of the VA primary provider. Retiring veterans
may also be eligible for TRICARE. It is a Medicare-wraparound
coverage for those that have Medicare Part A and B.
There are two US government-run programs available to children
from low-income households. Depending on income level, they may
qualify for Medicaid or the Children’s Health Insurance Program
(CHIP). CHIP is a state-administered public program created in 1997
for children in low-income families that earn too much to qualify for
Medicaid but are unlikely to be able to afford private insurance. CHIP
is funded through matching grants from the federal government to the
states, and most states charge a low premium and have small copays,
if any. Because it is state-administered, exactly how it works varies by
state. For example, it is considered an extension of Medicaid in some
lOMoARcPSD|61746433
states, while in others it is a separate program. Currently, 9.6 million
children are covered by this program.
Coverage of Medications
In Japan, the coverage for medication for children, the unemployed,
and the retired remain under the same rules as the coinsurance
percentages. Clinics can dispense medication directly to the patients or
they can go to the pharmacy. According to the Commonwealth Fund,
the use of pharmacies has been growing. Price revisions for
medications are also revised every 2 years. Usually, prices are lowered
for new drugs that are selling more than expected, and for brand-name
drugs when their generic counterparts become available. Prices of
generic drugs have gradually decreased. Also, if a physician
prescribes more than 6 drugs regularly to a patient, he receives a
reduced fee as a way to improve clinical decision-making.
In the US, the coverage for medication for children, the unemployed,
the and retired depends on the coverage they have.
Retired individuals with Medicare have the option to purchase private
prescription drug coverage under Medicare Part D. Part D covers most
outpatient drugs, like those that you would get a prescription for and
pick up at the pharmacy. Medicare Part B only covers very limited
outpatient prescription drug benefits, like injections that need to be
given by a medical professional. For Medicare Part D, copays and
coinsurance vary by drug plan: $0–$5 for preferred generics, up to
50% for non-preferred drugs. For the unemployed that qualify for
Medicaid, outpatient prescription drugs are an optional benefit under
federal law, however, currently, all states provide drug coverage. For
children with private health insurance, the copay for prescriptions
lOMoARcPSD|61746433
depends on that specific insurance coverage. For low-income children,
the copay for medications is reduced if part of CHIP or possibly free if
on Medicaid. Vaccines are often free to uninsured and underinsured
children.
Referral to See a Specialist
In Japan, there is no 'gatekeeper'. Children, the unemployed, and the
retired do not need to get a referral to go see a specialist. The term
'general practice' in Japan is recent, but historically, there has been no
distinction between primary care and specialty care. The fee schedule
remains the same for all providers. Patients can see a specialist
without a referral and most of the time on a walk-in basis.
A 'gatekeeper' is very common for healthcare coverage in the United
States. American children, the unemployed, and the retired are often
limited to specialty services if it is not deemed necessary or they
cannot afford the excessive fees. PPO plans often can schedule an
appointment with a specialist without permission from their primary
care provider, but those with an HMO or government-sponsored plan
do not have that option. Outpatient specialists are free to choose which
form of insurance they will accept, or whether they will accept it at
all. For example, not all specialists accept publicly insured patients,
because of the relatively lower reimbursement rates set by Medicaid
and Medicare. Access to specialists for beneficiaries of these
programs—not to mention for people without any insurance—can
therefore be particularly limited.
Coverage for Preexisting Conditions
In Japan, no one can be excluded from any coverage based on a
preexisting condition. This also became true in the United States.
lOMoARcPSD|61746433
Under current law, health insurance companies can’t refuse to cover
you or charge you more just because you have a 'pre-existing
condition', that is, a health problem you had before the date that new
health coverage starts.
Finance Implications for Healthcare Delivery
In Japan, people benefit from the universal healthcare delivery system.
All fees are determined by the government and therefore controlled.
Even though most hospitals and medical offices are privately run, they
are limited on what they can charge based on government regulations.
This allows individuals to seek medical treatment and preventative
services more often, thus leading to better health. Not only is health
benefited but a person benefits financially as well. Unlike Americans,
the Japanese do not need to worry that paying for healthcare will lead
to financial ruin. A hospital stay is in the hundreds, whereas in the
United States, it is in the thousand and can leave a person bankrupt.
Americans often go without medical treatment simply based on the
fact that they cannot afford it. Especially if they do not have health
insurance, like in the circumstance of losing a job. In Japan, if a
person loses their job their health coverage just switches from the
employer to a community plan.
The negative financial implications of Japan’s healthcare structure fall
on the providers. 50% of hospitals are in financial deficit. This is the
opposite in America, where hospitals and doctors make a profit at the
expense of the people. In America private practices can, and often do,
refuse services to those with government-sponsored insurance like
Medicaid. This is mostly due to the low reimbursement and the length
of time to receive payment. This is not allowed in Japan. There are
lOMoARcPSD|61746433
also disincentives for providers prescribing certain medications or
services because the price is then lowered upon the next government
review of fees. Again, this benefits the consumer, not the provider.
In America, both public and private insurers determine their benefit
packages and cost-sharing structures as long as it is within federal and
state regulations. Private insurers in America are for-profit, while
Japan’s statutory health insurance system (SHIS) is a not-for-profit
system. Insurers in Japan are not out to make a profit. Anything
money not used is carried over to the next year, which could lead to
premiums being reduced.
Conclusion
In summary, the comparative analysis covered in this essay has shown
that the healthcare systems of Japan and America, although they share
some common features, are nevertheless different. As for me, I would
prefer the Japanese system, for its accessibility, simplicity, and
orientation for the benefit of its population.
The United States does not have a universal healthcare system. Health
care coverage in the United States is a mixture of public and private,
as well as for-profit and nonprofit insurers. Options include fee-for-
service (FFS), preferred provider organization (PPO), point of service
(POS), health maintenance organization (HMO), Medicare, Medicaid,
and coverage from the Veterans Health Administration. A majority of
US citizens have private insurance that is often provided through their
employer, or they may buy it on their own. 12.5% of US adults are
uninsured, and countless more are underinsured. Lack of health
insurance is perhaps the greatest barrier to accessing health care
lOMoARcPSD|61746433
services and has a tremendous negative effect on an individual’s
overall health status.
The only thing close to a universal healthcare system in the United
States is the Patient Protection and Affordable Care Act ( PPACA),
which was signed into law in 2010. Its goal was to expand health
insurance coverage to Americans that were uninsured while
controlling costs and improving the quality of healthcare. Since its
beginning, it has been under scrutiny, and many parts have been
amended, including removing the penalty fee for those that did not
have health insurance. With the implementation of the PPACA,
different plan options became available for people to obtain insurance,
but private insurance is the primary health coverage for two-thirds of
Americans (67%). Over half of all private insurance is through
employers. Most employer plans cover their employees and give
various options on the level of coverage and also the option to insure
their family. Rarely an employer pays the entire premium. Most of the
time the cost is shared between the employer and employee. Only
11% of private health insurance is purchased by individuals from for-
profit and nonprofit carriers.
In America, retirees/seniors qualify for Medicare. It is a complex fee-
for-service program consisting of parts, A-D. Part A provides hospital
insurance and Part B medical insurance. Members can choose to get
their coverage just through traditional Medicare, or they can choose to
enroll in Part C which is a private health maintenance organization
(HMO) called Medicare Advantage. Part D is also optional and is for
prescription drug coverage. Medicare is financed through a
lOMoARcPSD|61746433
combination of general federal taxes, a mandatory payroll tax that
pays for Part A, and individual premiums.
The unemployed may qualify for Medicaid if their income is low. It is
a jointly sponsored state and federal program that pays for medical
services for persons who are elderly, poor, blind, or disabled, and for
certain families with dependent children who meet specified income
guidelines. Medicaid is obtained through the state of residency. The
state then received federal matching for providing the health coverage.
Veterans can receive healthcare coverage from the Veterans Health
Administration. It is America’s largest integrated healthcare system
serving 9 million enrolled Veterans each year. Having other health
insurance coverage like Medicare, Medicaid, or private insurance
doesn’t affect getting VA healthcare benefits. Each veteran’s medical
benefits package is unique. Covered benefits depend on the 'priority
group' and the advice of the VA primary provider. Retiring veterans
may also be eligible for TRICARE. It is a Medicare-wraparound
coverage for those that have Medicare Part A and B.
There are two US government-run programs available to children
from low-income households. Depending on income level, they may
qualify for Medicaid or the Children’s Health Insurance Program
(CHIP). CHIP is a state-administered public program created in 1997
for children in low-income families that earn too much to qualify for
Medicaid but are unlikely to be able to afford private insurance. CHIP
is funded through matching grants from the federal government to the
states, and most states charge a low premium and have small copays,
if any. Because it is state-administered, exactly how it works varies by
state. For example, it is considered an extension of Medicaid in some
lOMoARcPSD|61746433
states, while in others it is a separate program. Currently, 9.6 million
children are covered by this program.
Coverage of Medications
In Japan, the coverage for medication for children, the unemployed,
and the retired remain under the same rules as the coinsurance
percentages. Clinics can dispense medication directly to the patients or
they can go to the pharmacy. According to the Commonwealth Fund,
the use of pharmacies has been growing. Price revisions for
medications are also revised every 2 years. Usually, prices are lowered
for new drugs that are selling more than expected, and for brand-name
drugs when their generic counterparts become available. Prices of
generic drugs have gradually decreased. Also, if a physician
prescribes more than 6 drugs regularly to a patient, he receives a
reduced fee as a way to improve clinical decision-making.
In the US, the coverage for medication for children, the unemployed,
the and retired depends on the coverage they have.
Retired individuals with Medicare have the option to purchase private
prescription drug coverage under Medicare Part D. Part D covers most
outpatient drugs, like those that you would get a prescription for and
pick up at the pharmacy. Medicare Part B only covers very limited
outpatient prescription drug benefits, like injections that need to be
given by a medical professional. For Medicare Part D, copays and
coinsurance vary by drug plan: $0–$5 for preferred generics, up to
50% for non-preferred drugs. For the unemployed that qualify for
Medicaid, outpatient prescription drugs are an optional benefit under
federal law, however, currently, all states provide drug coverage. For
children with private health insurance, the copay for prescriptions
lOMoARcPSD|61746433
depends on that specific insurance coverage. For low-income children,
the copay for medications is reduced if part of CHIP or possibly free if
on Medicaid. Vaccines are often free to uninsured and underinsured
children.
Referral to See a Specialist
In Japan, there is no 'gatekeeper'. Children, the unemployed, and the
retired do not need to get a referral to go see a specialist. The term
'general practice' in Japan is recent, but historically, there has been no
distinction between primary care and specialty care. The fee schedule
remains the same for all providers. Patients can see a specialist
without a referral and most of the time on a walk-in basis.
A 'gatekeeper' is very common for healthcare coverage in the United
States. American children, the unemployed, and the retired are often
limited to specialty services if it is not deemed necessary or they
cannot afford the excessive fees. PPO plans often can schedule an
appointment with a specialist without permission from their primary
care provider, but those with an HMO or government-sponsored plan
do not have that option. Outpatient specialists are free to choose which
form of insurance they will accept, or whether they will accept it at
all. For example, not all specialists accept publicly insured patients,
because of the relatively lower reimbursement rates set by Medicaid
and Medicare. Access to specialists for beneficiaries of these
programs—not to mention for people without any insurance—can
therefore be particularly limited.
Coverage for Preexisting Conditions
In Japan, no one can be excluded from any coverage based on a
preexisting condition. This also became true in the United States.
lOMoARcPSD|61746433
Under current law, health insurance companies can’t refuse to cover
you or charge you more just because you have a 'pre-existing
condition', that is, a health problem you had before the date that new
health coverage starts.
Finance Implications for Healthcare Delivery
In Japan, people benefit from the universal healthcare delivery system.
All fees are determined by the government and therefore controlled.
Even though most hospitals and medical offices are privately run, they
are limited on what they can charge based on government regulations.
This allows individuals to seek medical treatment and preventative
services more often, thus leading to better health. Not only is health
benefited but a person benefits financially as well. Unlike Americans,
the Japanese do not need to worry that paying for healthcare will lead
to financial ruin. A hospital stay is in the hundreds, whereas in the
United States, it is in the thousand and can leave a person bankrupt.
Americans often go without medical treatment simply based on the
fact that they cannot afford it. Especially if they do not have health
insurance, like in the circumstance of losing a job. In Japan, if a
person loses their job their health coverage just switches from the
employer to a community plan.
The negative financial implications of Japan’s healthcare structure fall
on the providers. 50% of hospitals are in financial deficit. This is the
opposite in America, where hospitals and doctors make a profit at the
expense of the people. In America private practices can, and often do,
refuse services to those with government-sponsored insurance like
Medicaid. This is mostly due to the low reimbursement and the length
of time to receive payment. This is not allowed in Japan. There are
lOMoARcPSD|61746433
also disincentives for providers prescribing certain medications or
services because the price is then lowered upon the next government
review of fees. Again, this benefits the consumer, not the provider.
In America, both public and private insurers determine their benefit
packages and cost-sharing structures as long as it is within federal and
state regulations. Private insurers in America are for-profit, while
Japan’s statutory health insurance system (SHIS) is a not-for-profit
system. Insurers in Japan are not out to make a profit. Anything
money not used is carried over to the next year, which could lead to
premiums being reduced.
Conclusion
In summary, the comparative analysis covered in this essay has shown
that the healthcare systems of Japan and America, although they share
some common features, are nevertheless different. As for me, I would
prefer the Japanese system, for its accessibility, simplicity, and
orientation for the benefit of its population.
The United States does not have a universal healthcare system. Health
care coverage in the United States is a mixture of public and private,
as well as for-profit and nonprofit insurers. Options include fee-for-
service (FFS), preferred provider organization (PPO), point of service
(POS), health maintenance organization (HMO), Medicare, Medicaid,
and coverage from the Veterans Health Administration. A majority of
US citizens have private insurance that is often provided through their
employer, or they may buy it on their own. 12.5% of US adults are
uninsured, and countless more are underinsured. Lack of health
insurance is perhaps the greatest barrier to accessing health care
lOMoARcPSD|61746433
services and has a tremendous negative effect on an individual’s
overall health status.
The only thing close to a universal healthcare system in the United
States is the Patient Protection and Affordable Care Act ( PPACA),
which was signed into law in 2010. Its goal was to expand health
insurance coverage to Americans that were uninsured while
controlling costs and improving the quality of healthcare. Since its
beginning, it has been under scrutiny, and many parts have been
amended, including removing the penalty fee for those that did not
have health insurance. With the implementation of the PPACA,
different plan options became available for people to obtain insurance,
but private insurance is the primary health coverage for two-thirds of
Americans (67%). Over half of all private insurance is through
employers. Most employer plans cover their employees and give
various options on the level of coverage and also the option to insure
their family. Rarely an employer pays the entire premium. Most of the
time the cost is shared between the employer and employee. Only
11% of private health insurance is purchased by individuals from for-
profit and nonprofit carriers.
In America, retirees/seniors qualify for Medicare. It is a complex fee-
for-service program consisting of parts, A-D. Part A provides hospital
insurance and Part B medical insurance. Members can choose to get
their coverage just through traditional Medicare, or they can choose to
enroll in Part C which is a private health maintenance organization
(HMO) called Medicare Advantage. Part D is also optional and is for
prescription drug coverage. Medicare is financed through a
lOMoARcPSD|61746433
combination of general federal taxes, a mandatory payroll tax that
pays for Part A, and individual premiums.
The unemployed may qualify for Medicaid if their income is low. It is
a jointly sponsored state and federal program that pays for medical
services for persons who are elderly, poor, blind, or disabled, and for
certain families with dependent children who meet specified income
guidelines. Medicaid is obtained through the state of residency. The
state then received federal matching for providing the health coverage.
Veterans can receive healthcare coverage from the Veterans Health
Administration. It is America’s largest integrated healthcare system
serving 9 million enrolled Veterans each year. Having other health
insurance coverage like Medicare, Medicaid, or private insurance
doesn’t affect getting VA healthcare benefits. Each veteran’s medical
benefits package is unique. Covered benefits depend on the 'priority
group' and the advice of the VA primary provider. Retiring veterans
may also be eligible for TRICARE. It is a Medicare-wraparound
coverage for those that have Medicare Part A and B.
There are two US government-run programs available to children
from low-income households. Depending on income level, they may
qualify for Medicaid or the Children’s Health Insurance Program
(CHIP). CHIP is a state-administered public program created in 1997
for children in low-income families that earn too much to qualify for
Medicaid but are unlikely to be able to afford private insurance. CHIP
is funded through matching grants from the federal government to the
states, and most states charge a low premium and have small copays,
if any. Because it is state-administered, exactly how it works varies by
state. For example, it is considered an extension of Medicaid in some
lOMoARcPSD|61746433
states, while in others it is a separate program. Currently, 9.6 million
children are covered by this program.
Coverage of Medications
In Japan, the coverage for medication for children, the unemployed,
and the retired remain under the same rules as the coinsurance
percentages. Clinics can dispense medication directly to the patients or
they can go to the pharmacy. According to the Commonwealth Fund,
the use of pharmacies has been growing. Price revisions for
medications are also revised every 2 years. Usually, prices are lowered
for new drugs that are selling more than expected, and for brand-name
drugs when their generic counterparts become available. Prices of
generic drugs have gradually decreased. Also, if a physician
prescribes more than 6 drugs regularly to a patient, he receives a
reduced fee as a way to improve clinical decision-making.
In the US, the coverage for medication for children, the unemployed,
the and retired depends on the coverage they have.
Retired individuals with Medicare have the option to purchase private
prescription drug coverage under Medicare Part D. Part D covers most
outpatient drugs, like those that you would get a prescription for and
pick up at the pharmacy. Medicare Part B only covers very limited
outpatient prescription drug benefits, like injections that need to be
given by a medical professional. For Medicare Part D, copays and
coinsurance vary by drug plan: $0–$5 for preferred generics, up to
50% for non-preferred drugs. For the unemployed that qualify for
Medicaid, outpatient prescription drugs are an optional benefit under
federal law, however, currently, all states provide drug coverage. For
children with private health insurance, the copay for prescriptions
lOMoARcPSD|61746433
depends on that specific insurance coverage. For low-income children,
the copay for medications is reduced if part of CHIP or possibly free if
on Medicaid. Vaccines are often free to uninsured and underinsured
children.
Referral to See a Specialist
In Japan, there is no 'gatekeeper'. Children, the unemployed, and the
retired do not need to get a referral to go see a specialist. The term
'general practice' in Japan is recent, but historically, there has been no
distinction between primary care and specialty care. The fee schedule
remains the same for all providers. Patients can see a specialist
without a referral and most of the time on a walk-in basis.
A 'gatekeeper' is very common for healthcare coverage in the United
States. American children, the unemployed, and the retired are often
limited to specialty services if it is not deemed necessary or they
cannot afford the excessive fees. PPO plans often can schedule an
appointment with a specialist without permission from their primary
care provider, but those with an HMO or government-sponsored plan
do not have that option. Outpatient specialists are free to choose which
form of insurance they will accept, or whether they will accept it at
all. For example, not all specialists accept publicly insured patients,
because of the relatively lower reimbursement rates set by Medicaid
and Medicare. Access to specialists for beneficiaries of these
programs—not to mention for people without any insurance—can
therefore be particularly limited.
Coverage for Preexisting Conditions
In Japan, no one can be excluded from any coverage based on a
preexisting condition. This also became true in the United States.
lOMoARcPSD|61746433
Under current law, health insurance companies can’t refuse to cover
you or charge you more just because you have a 'pre-existing
condition', that is, a health problem you had before the date that new
health coverage starts.
Finance Implications for Healthcare Delivery
In Japan, people benefit from the universal healthcare delivery system.
All fees are determined by the government and therefore controlled.
Even though most hospitals and medical offices are privately run, they
are limited on what they can charge based on government regulations.
This allows individuals to seek medical treatment and preventative
services more often, thus leading to better health. Not only is health
benefited but a person benefits financially as well. Unlike Americans,
the Japanese do not need to worry that paying for healthcare will lead
to financial ruin. A hospital stay is in the hundreds, whereas in the
United States, it is in the thousand and can leave a person bankrupt.
Americans often go without medical treatment simply based on the
fact that they cannot afford it. Especially if they do not have health
insurance, like in the circumstance of losing a job. In Japan, if a
person loses their job their health coverage just switches from the
employer to a community plan.
The negative financial implications of Japan’s healthcare structure fall
on the providers. 50% of hospitals are in financial deficit. This is the
opposite in America, where hospitals and doctors make a profit at the
expense of the people. In America private practices can, and often do,
refuse services to those with government-sponsored insurance like
Medicaid. This is mostly due to the low reimbursement and the length
of time to receive payment. This is not allowed in Japan. There are
lOMoARcPSD|61746433
also disincentives for providers prescribing certain medications or
services because the price is then lowered upon the next government
review of fees. Again, this benefits the consumer, not the provider.
In America, both public and private insurers determine their benefit
packages and cost-sharing structures as long as it is within federal and
state regulations. Private insurers in America are for-profit, while
Japan’s statutory health insurance system (SHIS) is a not-for-profit
system. Insurers in Japan are not out to make a profit. Anything
money not used is carried over to the next year, which could lead to
premiums being reduced.
Conclusion
In summary, the comparative analysis covered in this essay has shown
that the healthcare systems of Japan and America, although they share
some common features, are nevertheless different. As for me, I would
prefer the Japanese system, for its accessibility, simplicity, and
orientation for the benefit of its population.
The United States does not have a universal healthcare system. Health
care coverage in the United States is a mixture of public and private,
as well as for-profit and nonprofit insurers. Options include fee-for-
service (FFS), preferred provider organization (PPO), point of service
(POS), health maintenance organization (HMO), Medicare, Medicaid,
and coverage from the Veterans Health Administration. A majority of
US citizens have private insurance that is often provided through their
employer, or they may buy it on their own. 12.5% of US adults are
uninsured, and countless more are underinsured. Lack of health
insurance is perhaps the greatest barrier to accessing health care
lOMoARcPSD|61746433
services and has a tremendous negative effect on an individual’s
overall health status.
The only thing close to a universal healthcare system in the United
States is the Patient Protection and Affordable Care Act ( PPACA),
which was signed into law in 2010. Its goal was to expand health
insurance coverage to Americans that were uninsured while
controlling costs and improving the quality of healthcare. Since its
beginning, it has been under scrutiny, and many parts have been
amended, including removing the penalty fee for those that did not
have health insurance. With the implementation of the PPACA,
different plan options became available for people to obtain insurance,
but private insurance is the primary health coverage for two-thirds of
Americans (67%). Over half of all private insurance is through
employers. Most employer plans cover their employees and give
various options on the level of coverage and also the option to insure
their family. Rarely an employer pays the entire premium. Most of the
time the cost is shared between the employer and employee. Only
11% of private health insurance is purchased by individuals from for-
profit and nonprofit carriers.
In America, retirees/seniors qualify for Medicare. It is a complex fee-
for-service program consisting of parts, A-D. Part A provides hospital
insurance and Part B medical insurance. Members can choose to get
their coverage just through traditional Medicare, or they can choose to
enroll in Part C which is a private health maintenance organization
(HMO) called Medicare Advantage. Part D is also optional and is for
prescription drug coverage. Medicare is financed through a
lOMoARcPSD|61746433
combination of general federal taxes, a mandatory payroll tax that
pays for Part A, and individual premiums.
The unemployed may qualify for Medicaid if their income is low. It is
a jointly sponsored state and federal program that pays for medical
services for persons who are elderly, poor, blind, or disabled, and for
certain families with dependent children who meet specified income
guidelines. Medicaid is obtained through the state of residency. The
state then received federal matching for providing the health coverage.
Veterans can receive healthcare coverage from the Veterans Health
Administration. It is America’s largest integrated healthcare system
serving 9 million enrolled Veterans each year. Having other health
insurance coverage like Medicare, Medicaid, or private insurance
doesn’t affect getting VA healthcare benefits. Each veteran’s medical
benefits package is unique. Covered benefits depend on the 'priority
group' and the advice of the VA primary provider. Retiring veterans
may also be eligible for TRICARE. It is a Medicare-wraparound
coverage for those that have Medicare Part A and B.
There are two US government-run programs available to children
from low-income households. Depending on income level, they may
qualify for Medicaid or the Children’s Health Insurance Program
(CHIP). CHIP is a state-administered public program created in 1997
for children in low-income families that earn too much to qualify for
Medicaid but are unlikely to be able to afford private insurance. CHIP
is funded through matching grants from the federal government to the
states, and most states charge a low premium and have small copays,
if any. Because it is state-administered, exactly how it works varies by
state. For example, it is considered an extension of Medicaid in some
lOMoARcPSD|61746433
states, while in others it is a separate program. Currently, 9.6 million
children are covered by this program.
Coverage of Medications
In Japan, the coverage for medication for children, the unemployed,
and the retired remain under the same rules as the coinsurance
percentages. Clinics can dispense medication directly to the patients or
they can go to the pharmacy. According to the Commonwealth Fund,
the use of pharmacies has been growing. Price revisions for
medications are also revised every 2 years. Usually, prices are lowered
for new drugs that are selling more than expected, and for brand-name
drugs when their generic counterparts become available. Prices of
generic drugs have gradually decreased. Also, if a physician
prescribes more than 6 drugs regularly to a patient, he receives a
reduced fee as a way to improve clinical decision-making.
In the US, the coverage for medication for children, the unemployed,
the and retired depends on the coverage they have.
Retired individuals with Medicare have the option to purchase private
prescription drug coverage under Medicare Part D. Part D covers most
outpatient drugs, like those that you would get a prescription for and
pick up at the pharmacy. Medicare Part B only covers very limited
outpatient prescription drug benefits, like injections that need to be
given by a medical professional. For Medicare Part D, copays and
coinsurance vary by drug plan: $0–$5 for preferred generics, up to
50% for non-preferred drugs. For the unemployed that qualify for
Medicaid, outpatient prescription drugs are an optional benefit under
federal law, however, currently, all states provide drug coverage. For
children with private health insurance, the copay for prescriptions
lOMoARcPSD|61746433
depends on that specific insurance coverage. For low-income children,
the copay for medications is reduced if part of CHIP or possibly free if
on Medicaid. Vaccines are often free to uninsured and underinsured
children.
Referral to See a Specialist
In Japan, there is no 'gatekeeper'. Children, the unemployed, and the
retired do not need to get a referral to go see a specialist. The term
'general practice' in Japan is recent, but historically, there has been no
distinction between primary care and specialty care. The fee schedule
remains the same for all providers. Patients can see a specialist
without a referral and most of the time on a walk-in basis.
A 'gatekeeper' is very common for healthcare coverage in the United
States. American children, the unemployed, and the retired are often
limited to specialty services if it is not deemed necessary or they
cannot afford the excessive fees. PPO plans often can schedule an
appointment with a specialist without permission from their primary
care provider, but those with an HMO or government-sponsored plan
do not have that option. Outpatient specialists are free to choose which
form of insurance they will accept, or whether they will accept it at
all. For example, not all specialists accept publicly insured patients,
because of the relatively lower reimbursement rates set by Medicaid
and Medicare. Access to specialists for beneficiaries of these
programs—not to mention for people without any insurance—can
therefore be particularly limited.
Coverage for Preexisting Conditions
In Japan, no one can be excluded from any coverage based on a
preexisting condition. This also became true in the United States.
lOMoARcPSD|61746433
Under current law, health insurance companies can’t refuse to cover
you or charge you more just because you have a 'pre-existing
condition', that is, a health problem you had before the date that new
health coverage starts.
Finance Implications for Healthcare Delivery
In Japan, people benefit from the universal healthcare delivery system.
All fees are determined by the government and therefore controlled.
Even though most hospitals and medical offices are privately run, they
are limited on what they can charge based on government regulations.
This allows individuals to seek medical treatment and preventative
services more often, thus leading to better health. Not only is health
benefited but a person benefits financially as well. Unlike Americans,
the Japanese do not need to worry that paying for healthcare will lead
to financial ruin. A hospital stay is in the hundreds, whereas in the
United States, it is in the thousand and can leave a person bankrupt.
Americans often go without medical treatment simply based on the
fact that they cannot afford it. Especially if they do not have health
insurance, like in the circumstance of losing a job. In Japan, if a
person loses their job their health coverage just switches from the
employer to a community plan.
The negative financial implications of Japan’s healthcare structure fall
on the providers. 50% of hospitals are in financial deficit. This is the
opposite in America, where hospitals and doctors make a profit at the
expense of the people. In America private practices can, and often do,
refuse services to those with government-sponsored insurance like
Medicaid. This is mostly due to the low reimbursement and the length
of time to receive payment. This is not allowed in Japan. There are
lOMoARcPSD|61746433
also disincentives for providers prescribing certain medications or
services because the price is then lowered upon the next government
review of fees. Again, this benefits the consumer, not the provider.
In America, both public and private insurers determine their benefit
packages and cost-sharing structures as long as it is within federal and
state regulations. Private insurers in America are for-profit, while
Japan’s statutory health insurance system (SHIS) is a not-for-profit
system. Insurers in Japan are not out to make a profit. Anything
money not used is carried over to the next year, which could lead to
premiums being reduced.
Conclusion
In summary, the comparative analysis covered in this essay has shown
that the healthcare systems of Japan and America, although they share
some common features, are nevertheless different. As for me, I would
prefer the Japanese system, for its accessibility, simplicity, and
orientation for the benefit of its population.
The United States does not have a universal healthcare system. Health
care coverage in the United States is a mixture of public and private,
as well as for-profit and nonprofit insurers. Options include fee-for-
service (FFS), preferred provider organization (PPO), point of service
(POS), health maintenance organization (HMO), Medicare, Medicaid,
and coverage from the Veterans Health Administration. A majority of
US citizens have private insurance that is often provided through their
employer, or they may buy it on their own. 12.5% of US adults are
uninsured, and countless more are underinsured. Lack of health
insurance is perhaps the greatest barrier to accessing health care
lOMoARcPSD|61746433
services and has a tremendous negative effect on an individual’s
overall health status.
The only thing close to a universal healthcare system in the United
States is the Patient Protection and Affordable Care Act ( PPACA),
which was signed into law in 2010. Its goal was to expand health
insurance coverage to Americans that were uninsured while
controlling costs and improving the quality of healthcare. Since its
beginning, it has been under scrutiny, and many parts have been
amended, including removing the penalty fee for those that did not
have health insurance. With the implementation of the PPACA,
different plan options became available for people to obtain insurance,
but private insurance is the primary health coverage for two-thirds of
Americans (67%). Over half of all private insurance is through
employers. Most employer plans cover their employees and give
various options on the level of coverage and also the option to insure
their family. Rarely an employer pays the entire premium. Most of the
time the cost is shared between the employer and employee. Only
11% of private health insurance is purchased by individuals from for-
profit and nonprofit carriers.
In America, retirees/seniors qualify for Medicare. It is a complex fee-
for-service program consisting of parts, A-D. Part A provides hospital
insurance and Part B medical insurance. Members can choose to get
their coverage just through traditional Medicare, or they can choose to
enroll in Part C which is a private health maintenance organization
(HMO) called Medicare Advantage. Part D is also optional and is for
prescription drug coverage. Medicare is financed through a
lOMoARcPSD|61746433
combination of general federal taxes, a mandatory payroll tax that
pays for Part A, and individual premiums.
The unemployed may qualify for Medicaid if their income is low. It is
a jointly sponsored state and federal program that pays for medical
services for persons who are elderly, poor, blind, or disabled, and for
certain families with dependent children who meet specified income
guidelines. Medicaid is obtained through the state of residency. The
state then received federal matching for providing the health coverage.
Veterans can receive healthcare coverage from the Veterans Health
Administration. It is America’s largest integrated healthcare system
serving 9 million enrolled Veterans each year. Having other health
insurance coverage like Medicare, Medicaid, or private insurance
doesn’t affect getting VA healthcare benefits. Each veteran’s medical
benefits package is unique. Covered benefits depend on the 'priority
group' and the advice of the VA primary provider. Retiring veterans
may also be eligible for TRICARE. It is a Medicare-wraparound
coverage for those that have Medicare Part A and B.
There are two US government-run programs available to children
from low-income households. Depending on income level, they may
qualify for Medicaid or the Children’s Health Insurance Program
(CHIP). CHIP is a state-administered public program created in 1997
for children in low-income families that earn too much to qualify for
Medicaid but are unlikely to be able to afford private insurance. CHIP
is funded through matching grants from the federal government to the
states, and most states charge a low premium and have small copays,
if any. Because it is state-administered, exactly how it works varies by
state. For example, it is considered an extension of Medicaid in some
lOMoARcPSD|61746433
states, while in others it is a separate program. Currently, 9.6 million
children are covered by this program.
Coverage of Medications
In Japan, the coverage for medication for children, the unemployed,
and the retired remain under the same rules as the coinsurance
percentages. Clinics can dispense medication directly to the patients or
they can go to the pharmacy. According to the Commonwealth Fund,
the use of pharmacies has been growing. Price revisions for
medications are also revised every 2 years. Usually, prices are lowered
for new drugs that are selling more than expected, and for brand-name
drugs when their generic counterparts become available. Prices of
generic drugs have gradually decreased. Also, if a physician
prescribes more than 6 drugs regularly to a patient, he receives a
reduced fee as a way to improve clinical decision-making.
In the US, the coverage for medication for children, the unemployed,
the and retired depends on the coverage they have.
Retired individuals with Medicare have the option to purchase private
prescription drug coverage under Medicare Part D. Part D covers most
outpatient drugs, like those that you would get a prescription for and
pick up at the pharmacy. Medicare Part B only covers very limited
outpatient prescription drug benefits, like injections that need to be
given by a medical professional. For Medicare Part D, copays and
coinsurance vary by drug plan: $0–$5 for preferred generics, up to
50% for non-preferred drugs. For the unemployed that qualify for
Medicaid, outpatient prescription drugs are an optional benefit under
federal law, however, currently, all states provide drug coverage. For
children with private health insurance, the copay for prescriptions
lOMoARcPSD|61746433
depends on that specific insurance coverage. For low-income children,
the copay for medications is reduced if part of CHIP or possibly free if
on Medicaid. Vaccines are often free to uninsured and underinsured
children.
Referral to See a Specialist
In Japan, there is no 'gatekeeper'. Children, the unemployed, and the
retired do not need to get a referral to go see a specialist. The term
'general practice' in Japan is recent, but historically, there has been no
distinction between primary care and specialty care. The fee schedule
remains the same for all providers. Patients can see a specialist
without a referral and most of the time on a walk-in basis.
A 'gatekeeper' is very common for healthcare coverage in the United
States. American children, the unemployed, and the retired are often
limited to specialty services if it is not deemed necessary or they
cannot afford the excessive fees. PPO plans often can schedule an
appointment with a specialist without permission from their primary
care provider, but those with an HMO or government-sponsored plan
do not have that option. Outpatient specialists are free to choose which
form of insurance they will accept, or whether they will accept it at
all. For example, not all specialists accept publicly insured patients,
because of the relatively lower reimbursement rates set by Medicaid
and Medicare. Access to specialists for beneficiaries of these
programs—not to mention for people without any insurance—can
therefore be particularly limited.
Coverage for Preexisting Conditions
In Japan, no one can be excluded from any coverage based on a
preexisting condition. This also became true in the United States.
lOMoARcPSD|61746433
Under current law, health insurance companies can’t refuse to cover
you or charge you more just because you have a 'pre-existing
condition', that is, a health problem you had before the date that new
health coverage starts.
Finance Implications for Healthcare Delivery
In Japan, people benefit from the universal healthcare delivery system.
All fees are determined by the government and therefore controlled.
Even though most hospitals and medical offices are privately run, they
are limited on what they can charge based on government regulations.
This allows individuals to seek medical treatment and preventative
services more often, thus leading to better health. Not only is health
benefited but a person benefits financially as well. Unlike Americans,
the Japanese do not need to worry that paying for healthcare will lead
to financial ruin. A hospital stay is in the hundreds, whereas in the
United States, it is in the thousand and can leave a person bankrupt.
Americans often go without medical treatment simply based on the
fact that they cannot afford it. Especially if they do not have health
insurance, like in the circumstance of losing a job. In Japan, if a
person loses their job their health coverage just switches from the
employer to a community plan.
The negative financial implications of Japan’s healthcare structure fall
on the providers. 50% of hospitals are in financial deficit. This is the
opposite in America, where hospitals and doctors make a profit at the
expense of the people. In America private practices can, and often do,
refuse services to those with government-sponsored insurance like
Medicaid. This is mostly due to the low reimbursement and the length
of time to receive payment. This is not allowed in Japan. There are
lOMoARcPSD|61746433
also disincentives for providers prescribing certain medications or
services because the price is then lowered upon the next government
review of fees. Again, this benefits the consumer, not the provider.
In America, both public and private insurers determine their benefit
packages and cost-sharing structures as long as it is within federal and
state regulations. Private insurers in America are for-profit, while
Japan’s statutory health insurance system (SHIS) is a not-for-profit
system. Insurers in Japan are not out to make a profit. Anything
money not used is carried over to the next year, which could lead to
premiums being reduced.
Conclusion
In summary, the comparative analysis covered in this essay has shown
that the healthcare systems of Japan and America, although they share
some common features, are nevertheless different. As for me, I would
prefer the Japanese system, for its accessibility, simplicity, and
orientation for the benefit of its population.
