Organizational Systems and Quality Leadership
Comparing health care systems of the United States and Germany. Assessing the areas of health care for adults’ elderly and retired, coverage for prescriptions, referrals for testing and specialties including pre-existing conditions, and financial effects and of course the children.
An evaluation of the insurances for these two systems must be viewed including, different insurances available and the individuals covered will be assessed. Germany has funds for sick individuals can purchase that are supported by taxes collected from employment (Thomas & Mossialos, 2010). The sick funds are primarily obtained from payer systems. In the United States, insurance may be employer based or coverage
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The coverage may only be a certain percentage or required that generic brands are substituted when available. Some medication may not be covered at all and the patient is responsible for the cost or may require that only certain pharmacies are used to obtain prescriptions. Certain groups are exempt from having fees to pay for prescriptions in Germany, they are children under 18 years of age and those with certain chronic illnesses.
Referrals for Specialties
The United States being referred for specialties depends on the insurance plan (Mossialos, Wenzel, Osborn, Sarnak, 2016, pp. 171-177). Health Maintenance Organization (HMO) plans give access to certain healthcare organizations and physician within their network that have agreed to lower rates for their services. The individual must agree to these services to have services covered. All services will be coordinated by the primary care physician PCP. Medicaid coverage is also based on these principles. Preferred Provider Organization (PPO) plan have higher premiums but give more flexibility. PPO allows the individual to see any physician they choose but cost is less if the individual stays within the network. PPO does not require that the individual have a PCP. No referrals for specialist are needed.
Any specialist that is reimbursed by Germany’s Statutory Health Insurance (SHI), anyone that has sickness funds can see a specialist and no referral is needed.
Pre-existing Conditions
Pre-existing
Germany’s healthcare system is split into two types of coverage which is public and private health insurance. Health insurance companies are not able to deny people coverage due to pre-existing illnesses or to discontinue their treatment because of high costs. The public health care insurance is provided by statute to individuals who are not eligible for private insurance which is people who are salary and make under $50,000 annually. As people age and become ill, they are able to opt out of their insurance and turn to the government’s option. As the economy continues to fluctuate, the population of Germany relies more heavily on the legislative insurance which consists of 85-90% of the population.
Germany’s health care system pays for not only healthcare basics but also dental, optical, mental health. They will also pay for alternative therapies like homeopathy, to go to a spa, and more. The healthcare system is highly accepted by the German population. Pregnant women pay nothing for their care, while most Germans have a co-pay of $15 dollars once every 3 months for their doctor visits (Saul, 2014).
There are many individuals’ that think the German health care system is one of the best in the world. Back in 1883 a man by the name of Otto von Bismarck, created Germany’s health care system; a universal health care system which is the oldest in Europe ("Otto von Bismarck," 2012). When the German health care system was created, it was mandatory for a select few mainly, low-income workers and specific government employees. Gradually the system was expanded to cover the entire German population. Under the German universal health care system 85 % of their population has
In comparison, the Canadian system features mandatory insurance, but this is purchased from the government rather than from private insurance companies. The coverage under this insurance is standardized across provinces and is guaranteed to all. The British system is similar, but without the insurance component since most funding comes from general taxation. The German system is something of a hybrid in that there are private insurance companies. There is mandatory insurance and private insurance, with the system being a total of 77% government-funded.
The Swiss healthcare adopted a system with the principles of universality and equality requiring all individuals to purchase health insurance on the private market, providing financial assistance to those on lower incomes, and regulating the insurance market to protect those with poor health. The current Swiss health care system came into effect in 1996 under the Health Insurance Law of 18 March 1994, introducing a managed health care system to provide full coverage in basic health insurance, which is regulated by the Federal Office of Public Health, and outlined the level of health care that patients should receive and allowed competition between insurers in enhancing standards and decreasing insurance premiums costs. Insurers require to accept all applicants, and cannot vary premiums based on the health of each consumer and make profits on basic package plans. Individuals are permitted to purchase supplementary insurance to fund additional health care, but other regulations are applied with regards to enrolment, for-profit status, and premium variations. Supplementary insurance is regulated by the Federal Office of Private Insurance and is voluntary. Primary care providers are funded through reimbursement from insurers (Holly, et al, 2004; Mossialos, et al., 2015).
Hospital Insurance benefits most Americans and does not require a monthly payment. The Supplementary Insurance Program is funded by monthly insurance premiums that people covered pay and money from the federal government. The government contributes the majority of the cost and gets the money to fund it from taxes. People who enroll pay small fees each year for medical costs above the allotted amount and a monthly payment. Supplementary Insurance pays 80% of medical bills but won't pay for routine checkups, medicines, glasses, hearing aids, dentures, or orthopedic shoes. Supplementary Insurance bases what it pays for on what they consider a reasonable charge for the kind of service (“Medicare”). If you can’t afford to pay the monthly premiums of Medicare and are elderly, disabled, or pregnant, Medicaid can provide healthcare. These two programs marked the beginning of many beneficial changes in the health industry. The government became more involved in healthcare and even started training new healthcare professionals, something that used to only be done by other healthcare professionals. Also, the insurance industry expanded as it tried to keep up with the government (Graetzer). The Great Society also gave funding to other health-related
In the Bismark model health care costs are covered jointly by employers and employees. The health care insurance is mandatory, has to be offered to every person. Insurance companies do not make profit from the system and they are not allowed by law to refuse to cover people who have a greater risk of developing a disease. Germany, France, Switzerland, Belgium, Netherlands, Japan are all examples of health care systems that employ the Bismark model. The United States uses the Bismark model as well, however, for profit and do not include all the citizens. In addition, most Americans get insurance through their
Most government financed systems are inclined to make available for every person living in the nation with treatment which proposes access to some fundamental level of care. Majority of people pay for coverage through taxes and additional charges. In government financed health care the government may provide care itself such as the United Kingdom or they may contact other providers to do so ex: Germany and Japan or in the United States
As some people were skeptical about the basis for the ranking, several studies were conducted, this time including “amenable mortality” in the criteria. France was first in the ranking. One good thing about France’s health care system is that everyone has health care. The country is also reported to rely on private and government insurance. Unlike the United States, France lets its citizens to have freedom in choosing hospitals, doctors, and care. Additionally, the health care system does not put much constrain on doctors with regards to making medical decisions. The same situation is evident on German health care system, where everyone has fully portable health insurance which comes with package of benefits. Like France, Germany lets its patients have freedom in choosing doctor and hospital during illness. A survey showed that patients and physicians in Germany are both satisfied with their health care system (Reinhardt, 1994, p.22).
Health insurance is the most important thing a person could have in their nation. In this chapter, it will compare the four nations and its health insurance plan. One thing to consider when reviewing a certain health insurance plan is how it will benefit you the most. The plan must coverage your needs as much as possible and it should also be as afforable. The four nations that this chapter will be reviewing is Germany, Canada, the United Kingdom, and Japan. All of these nations will explain thoroughly through their health insurance plan, its medical care, cost control, and how physicians and hospitals are paid.
Germany has a market based health system. They have universal health care that covers medical, dental, mental health and even homeopathy. Insurance companies cannot make a profit from insured customers. Therefore, the price for insurance is negotiated between the government and the Insurance provider. Like any other healthcare system there are
Is it possible for two countries which are thousands of kilometers away from each other to have some similarities in their health care system? Health care system is one of the most important and fundamental sectors in any country or region all around the world. Many countries pour a major amount of their overall income to support the health care system. And the main reason behind this tremendous effort provided by the countries all around the world for the health care system is that each country wants to provide a good and high standard health care services for all the population occupying the land whether they were local citizens or Non- local citizens . This essay will compare and contrast the health care system in two wonderful countries:
In the term of health care system structure, there are three providers of health service are: public hospitals, non-profit hospitals (run by the German Red Cross) and private hospitals. All people should have health insurance. That means insurance is obligatory matter and it plays a major role in the structure of Germany health system. There are two main types of health insurance in Germany. The first type is Compulsory Insurance (also know as Public Insurance or SHI). The second type is Private Insurance (also know as PHI). The situation of an individual; age, health and income determines which kind of insurance is best for him/her. In compulsory (public) insurance just the person’s income considered in order to determines the rate of the insurance. People with high income pay more than those with lower income to get their insurance. Age and health are not considered. The compulsory insurances offered by many companies in Germany, and there are main benefits selected by the government must be covered by every public insurance
For many years Germany has had one of the best in healthcare System in Europe. Its reputation is also one of the best among the world. There is an extensive network of Hospitals and doctors covering even the most remote area of Germany. It is very rear to find any type of wetting list for any type of treatment. Medical facilities are equipped with the latest technology and medicine research and development team of scientist. Currently, in Germany there is a great healthcare insurance system that cover approximately 90% of the Population with their statutory insurance system. Here in the U.S, we have what I would consider to be a private healthcare system. Every citizen is able to purchase their own private insurance. Either you can afford
The healthcare is provided by public hospitals, private not-for-profit hospitals, commercial, and large ambulatory care sector which are provided hugely by the practitioners who are working independently. In these practitioners in the ambulatory care, 53% are general practitioners while 47% are specialists. Two distinct policy domains are known to exist. The rates of payments are set by the government while general practitioners will negotiate for collective agreement with the healthcare insurance fund. One challenge that is found with this aspect is that the insurance fund does not cover the entire payment. Exceptions to this are for care during pregnancy, cover for serious chronic disease, or for poor patients who do not have funds to cover their medical expenses and are normally enrolled without any charge (Purnell, 2012). The average coverage from insurance is two-thirds, and nominal cover for devices like eye-glasses. This calls for people to subscribe to private complimentary healthcare insurance plan. This has come up with two-tier insurance for healthcare, where there is statutory healthcare and that of complementary private insurance.