Healthcare Financing USA and Germany Discussion Paper
Healthcare Financing USA and Germany Discussion Paper
Compare access between the two healthcare systems for children, unemployed, and retired people
The healthcare systems for children, people who are unemployed, and people who are retired in the U.S are very different from the healthcare system in Germany. These differences are due to the government’s role in each country’s healthcare system. In the United States, children receive healthcare through a parent or guardian. If a parent or guardian has insurance, their children can access public or private health insurance. In both cases, parents must pay part of their child’s care cost based on the family income level (Tikkanen & Abrams, 2020). Unemployed people must use the public health insurance program in the United States called Medicaid. In Germany, for children and unemployed people, there are public funds that supply healthcare. There are no private funds or public funds to pay for healthcare costs. For retirees, German pensioners do not pay into a fund to cover their healthcare costs. Employees whose regular wage exceeds the insurance threshold, public servants, clergy, private school instructors, pensioners, and self-employed persons are the only ones who can choose the private health insurance system over the SHI program (Döring & Paul, 2010). In the U.S, there is a fund called Social Security that pays out retirement income as well as pays into Medicare and Medicaid funds.
Discuss coverage for medications in the two healthcare systems
There are several medications for which the U.S and Germany have conflicting coverage. In the United States, several medications are not covered by public or private health insurance. These medications must be paid for out of pocket by the patient. On the other hand, Germany covers many of these drugs and medicines and pays for physical therapy. Healthcare Financing USA and Germany Discussion Paper
In both countries, prescription drug plans require people to pay a certain monthly amount to cover their prescriptions at a reduced cost. In the U.S, many people do not know they have access to drug plans through their employers and therefore do not take advantage of them. Germany does offer new health insurance for people who want to enroll in a drug plan. In Germany, treatment from a physician is accessible for people with a European Health Insurance Card. In the U.S, some physicians are paid by the government or by prescription drug companies to provide healthcare in addition to profits made by pharmaceutical companies.
Determine the requirements for a referral to see a specialist in the two healthcare systems
In the U.S, there are physicians and private hospitals that provide specialty care. It is common for an insurer to determine if a person can make a referral to a specialist. Germany does have many physicians who practice in the private sector, but they are not in competition with the public sector. The public sector restricts specialists from working with insurance companies or hospitals (Döring & Paul, 2010). There are requirements to get a referral to see many health insurance companies determine a specialist in the U.S. For example, you must have insurance or much money to pay for your healthcare to see a specialist. German doctors are not allowed to work with insurance companies or hospitals. The government is the only agency that can refer patients to specialists.
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Discuss coverage for pre-existing conditions in the two healthcare systems
Covering for pre-existing conditions in U.S healthcare is a matter of law if an individual applies for private health insurance. However, it is still possible for insurers and employers to deny coverage because of pre-existing conditions. Germany does cover people with pre-existing conditions, but they are not covered by public health insurance.
Explain two financial implications for patients concerning the healthcare delivery differences between the two countries
There is a direct financial implication for patients concerning the healthcare delivery differences between the two countries. For example, in the U.S., people have to pay much more for healthcare than in Germany. People on public health insurance must pay a portion of their healthcare costs out of pocket. The German government pays several healthcare costs for people who stay in Germany. If Germany allowed its people to be on public health insurance, there would be a considerable cost reduction.
There would be several financial implications for patients in the U.S if more care were provided through the public health insurance system instead of private insurance. The U.S public health insurance system is costly and does not cover many services and medications. The treatment in Germany is accessible to people who use public health insurance. Germany should allow their citizens to stay on public health insurance because the expenses would be much less than the current expenses. It would also reduce administrative costs as well as co-payments on medications.
References
Döring. A & Paul. F, (2010). The German healthcare system https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3405354/
Tikkanen. R & Abrams. J. M, (2020). The U.S. Health Care from a Global Perspective, 2019: Higher Spending, Worse Outcomes? https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019
