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Comparing Healthcare Systems

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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 …show more content…

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

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