INTRODUCTION
It is essential that nurses understand the issues related to healthcare financing, including local, state, and national healthcare policies and initiatives that affect healthcare delivery. As a patient advocate, the professional nurse is in a position to work with patients and families to access available resources to meet their healthcare needs.
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Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. An originality report is provided when you submit your task that can be used as a guide.
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You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.
A. Compare the U.S. healthcare system with the healthcare system of Great Britain, Japan, Germany, or Switzerland, by doing the following:
1. Identify one country from the following list whose healthcare system you will compare to the U.S. healthcare system: Great Britain, Japan, Germany, or Switzerland.
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2. Compare access between the two healthcare systems for children, people who are unemployed, and people who are retired.
a. Discuss coverage for medications in the two healthcare systems.
b. Determine the requirements to get a referral to see a specialist in the two healthcare systems.
c. Discuss coverage for preexisting conditions in the two healthcare systems.
3. Explain two financial implications for patients with regard to the healthcare delivery differences between the two countries (i.e.; how are the patients financially impacted).
B. Acknowledge sources, using in-text citations and references, for content that is quoted, paraphrased, or summarized.
C. Demonstrate professional communication in the content and presentation of your submission.
MODEL ANSWER
Every country has a unique healthcare system that defines the healthcare aspects for its citizens. The system eventually determines the budgetary allocations and other financial aspects that help determine the kind of healthcare citizens are | PLACE YOUR ORDER NOW AT writtask.com | the differences in these systems between one country to another, the standard protocols of service delivery and nurses’ roles as patient advocates are | PLACE YOUR ORDER NOW AT writtask.com | advocates, nurses must be part of the country’s policy formulation and ensure that the decisions made positively impact healthcare delivery. Besides, the nurse is expected to work with patients and healthcare providers in evaluating resources that can help address the healthcare needs of | PLACE YOUR ORDER NOW AT writtask.com | US healthcare system and that of Britain in terms of the children’s access to healthcare, the unemployed, and retirees. Besides, the coverage of medications in the healthcare systems of the two countries will also be explored.
Access to Children the Unemployed and Retirees
Access is one of the greatest components | PLACE YOUR ORDER NOW AT writtask.com | is to guarantee quality care for its citizens using policies that could be favorable to all citizens, including the marginalized, the less economically empowered citizens, and even the | PLACE YOUR ORDER NOW AT writtask.com | may not be the case as every country has its policies on healthcare access for specific patient populations.
In Great Britain, the government is in charge of all healthcare aspects, especially through | PLACE YOUR ORDER NOW AT writtask.com | National Health Service, the government provides free and universal coverage to | PLACE YOUR ORDER NOW AT writtask.com | starting from the ambulance services and the emergency room visits and long stays in hospital or complex surgical procedures are all provided free as they are part of the payroll taxes.
However, the situation is different in the US, which, through its Affordable Care Act of 2010, sought to have some shared responsibility between the employer, the government, and private individuals in guaranteeing quality | PLACE YOUR ORDER NOW AT writtask.com | are many options when it comes to the country’s health insurance, which is very fragmented. Private insurance companies are all dealt with from the level | PLACE YOUR ORDER NOW AT writtask.com | health insurance marketplaces that were set up in 2014 to help Americans access private health insurance coverage. Besides, the patients are entitled to choose a doctor within their network. This implies that most healthcare issues are run by insurance agencies rather than by the government in the US.
Access to healthcare for the children, the unemployed, and retirees is mainly run by the state, especially through private insurance | PLACE YOUR ORDER NOW AT writtask.com | are many health insurance coverage options, although most are very expensive and hence have to be handled at the | PLACE YOUR ORDER NOW AT writtask.com | initiatives specific for the vulnerable people in the society such as children, the unemployed, and those retired. The unemployed can access affordable health insurance plans available in the market. Another option is the coverage provided …
In the US, if a person retires before 65 and fail to use job-based health plan, they are eligible to use the Health Insurance marketplace to have an insurance plan Medicare which is the nation’s health insurance program pays for people aged 65 as long as they are eligible for | PLACE YOUR ORDER NOW AT writtask.com | is in charge of all the insurance coverage of retirees as the access to NHS doesn’t change when one retires. People will always have the freewill to …
Medication Coverage in the Healthcare Systems in the US and Britain
Medications that fall under the national health service | PLACE YOUR ORDER NOW AT writtask.com | co-payments (Palfreman & Reid, 2008). For the children that are below 16, the co-payments are waived. The situation is similar for individuals under the low-income bracket, the pregnant women, the elderly, those with disabilities, and those living with chronic | PLACE YOUR ORDER NOW AT writtask.com | in the US, where coverage for the medications is treated as part of one’s insurance plans as provided by insurance providers. Depending on the type of medications, there are different co-payments provided by the insurance plans. However, the children, the elderly, the disabled, and the low-income earners are given low-cost options.
The requirement for a referral to consult a specialist
It is a requirement in Great Britain that before a patient can see a specialist, the first step should be to see a primary care provider who officially refers to the | PLACE YOUR ORDER NOW AT writtask.com | similar in the US where, one must first see a primary caregiver before being referred to a specialist (Levy, Buchmueller & Nikpay, 2016). In the US, a written order from the primary giver is required to get certain medical | PLACE YOUR ORDER NOW AT writtask.com | Maintenance Organizations, one needs a referral before getting medical care from anyone other than the primary care doctor. The primary care physician is also responsible for recommending courses of treatment, medications, visits of specialists and other medical | PLACE YOUR ORDER NOW AT writtask.com | must however be made for services or specialist visits that are within the network. It is however, a requirement that the doctors being referred have to be within the insurance coverage system of the patient lest the visit will not be under the insurance cover making the payment to be very | PLACE YOUR ORDER NOW AT writtask.com | person visits a specialist without a referral, some specialists can still see the patient but Medicare may not cover the costs.
In Great Britain, the general practitioner can book a referral while one is at the surgery. Referral for specialist care can as well be booked online once the GP provides an appointment | PLACE YOUR ORDER NOW AT writtask.com | r-Referral services can also provide access to specialists.
Coverage for Pre-existing Conditions in Great Britain and the US
Patients with pre-existing conditions are often at higher risks of contracting other | PLACE YOUR ORDER NOW AT writtask.com | pre-existing conditions make them more vulnerable, and hence close medical attention is key. In Great Britain, these patients are covered under the universal health coverage scheme described by the NHS. On the contrary, the US doesn’t have a government-controlled insurance package for patients with pre-existing conditions. If the patient doesn’t have an insurance plan through which health payments can be made, most insurance companies shy away from handling patients with pre-existing | PLACE YOUR ORDER NOW AT writtask.com | condition is also a major hindrance to access to many health insurance plans, which negatively impacts the quality of care that people …
In most cases, the patient with these conditions is expected to take full responsibility | PLACE YOUR ORDER NOW AT writtask.com | requires that companies providing health insurance should not refuse to provide patients with the cover because of the pre-existing | PLACE YOUR ORDER NOW AT writtask.com | fully enforced, leaving most patients with pre-existing conditions lacking proper health coverage. Based on the current law, US health insurance companies a person with a pre-existing condition should not be denied care or be charged more due to the condition. The rules have been in existence since January 2014 after the enactment of the Affordable Care Act.
Financial Implications for Patients in regards to the differences in Healthcare delivery for the two Countries
Healthcare decisions and policy reforms will often have significant financial | PLACE YOUR ORDER NOW AT writtask.com | the NHS services are fully funded through taxes, citizens have to pay higher taxes for the government to accord them free healthcare services. In the US, the patient and | PLACE YOUR ORDER NOW AT writtask.com | the employer determine which kind of care they should seek. Failure to have health insurance can easily compromise the quality of care a patient is set to receive. Although the government has some insurance plans, it is often challenging for one to | PLACE YOUR ORDER NOW AT writtask.com | system is one of the most expensive despite the existence of insurance options. The continued healthcare reforms meant to improve healthcare access, especially for the vulnerable population, also result in higher taxes that can accord the country the highest budgetary healthcare allocation and other healthcare reforms.
References
Horowitz, I. (2017). Thinking about health care in the United States and Great Britain: A half-century perspective. In Eli Ginzberg (pp. 49-58). Routledge.
Levy, H., Buchmueller, T., & Nikpay, S. (2016). Health reform and health insurance coverage of early retirees. Michigan Retirement Research Center Research Paper, (2016-345).
Palfreman, J. and Reid, T. R. (April 15, 2008). Sick around the world. Great Britain: A leader in preventive medicine. Retrieved from: http://www.pbs.org/wgbh/pages/frontline/video/flv/generic.html?s=frol02n71cq101
Wisk, L. E., Peltz, A., & Galbraith, A. A. (2020). Changes in health care–related financial burden for US families with children associated with the Affordable Care Act. JAMA Pediatrics. doi:10.1001/jamapediatrics.2020.3973
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