Healthcare Financing Impacting Patient Outcomes

Introduction

The phrase healthcare finance describes the role of the healthcare system in accumulating, mobilizing, and allocating funds to meet the requirements of the ailing. Nurses who are the main personnel in the health care systems must understand the issues related to financing. The nurse can assist patients as well as their families in gaining access to various services to suit their needs. This essay focuses on local, regional, and national healthcare regulations and efforts that impact patient outcomes. It furthers shows the comparison between the Japan and United States healthcare systems.

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Healthcare System in the US

The U.S healthcare system is unique as compared to other countries. Most of the residents depend on private health insurance coverage for healing. Other seniors and the poor receive medical offers from Medicare and Medicaid programs. Children are served by a number of services, including TRICARE, health coverage program for children, Medicaid, employer-funded medical cover, and individual healthcare program (Koeckert et al., 2019). Medicaid is a federal-state run program mainly concerned with healthcare services to children from low income families and those individuals with special needs. The CHIP cares for pregnant women and children who cannot access Medicaid and finds it hard to get private insurance (Bielecki & Nieszporska, 2019). These two programs are jointly funded by the federal state, and they are responsible for children’s regular checkups for better health. The Employer Sponsored Insurance mainly covers children whose parents are employed, whereas the TRICARE programs covers children for retired military members, reserves, active duty, and the eligible families.

Employed People and Retired People

When one is privately employed, the employer is responsible for issuing private health insurance, or alternatively, one can buy their own. To purchase, one can select a plan which is best from the Affordable Care Act that offers subsidies to those who cannot afford high insurance premium plans. Those employed by the government get health insurance from the government as this is one of its role as an employer. If a person retires before 65 years and loses their job, they are required to purchase a healthcare plan (Koeckert et al., 2019). Some have retiree health coverage that takes care of them in their old age. Medicare is freely available to individuals who retire when they reach 65 years and above.

In order to get a recommendation to see a medical expert in the United States, an individual’s physician must first keep track of all the medical records, and detailed routine care must be provided. A referral from the primary care physician is needed unless it is an emergency. Without this referral, the insurance cannot work, and one will be responsible for all costs incurred (Koeckert et al., 2019). The coverage for preexisting conditions is not covered under insurance cover but catered for by the Affordable Care Act to help patients access services that are denied by private insurance.

Japan Healthcare System

Japan is the country to be compared with the U.S health system. Its care systems consist of two parts, namely, the National Health Insurance and the Employers Health Insurance. While there is universal health care provision for adults, the National Health Insurance is available for children. Parents can add their children to their insurance and use it when seeking treatment. Children can also apply for free Medical Care Certificates from the ward or city and use them. Other baby checkups and vaccinations are not covered in insurances but are offered through coupons by ward or city officers. The employed receive health insurance certificates in which their premiums are determined by their salary scale (Suzuki et al., 2020). The retired are given an old age pension to cover the medical requirements. To get access to a specialist, one may not need to have a referral. All one requires is to book an appointment online and show up at the clinic for checkups. In Japan, costs for the treatment of preexisting conditions are covered by the government.

Comparison Between the Two Healthcare Systems

In comparison, the U.S government does not guarantee a universal health care plan compared to the Japanese government. In Japan, the healthcare system consists of National Health Insurance and Employer Health Insurance, while in the US, most residents depend on programs that provide care services. Children care plans in the U.S depend on special programs for checkups and other treatment plans. In Japan, the national health insurance is available for children, and they can also apply for Medical Care Certificates (Koeckert et al., 2019). Children programs are jointly funded by the federal state in the U.S, while in Japan, coupons are offered by the ward officers. In order to see a specialist in the U.S, one must have a referral from a physician, while in Japan, there is no need to get a referral. In Japan, the government covers the pre-existing conditions expenses, whereas it is not a government initiative but done by the Affordable Care Act in the U.S. In both countries, the elderly who have retired are given healthcare services through their monthly insurance savings.

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Financial Implications

The financial implications refer to the outcomes of any financial decision realized. The patients depend on a variety of sources to get money. Insurance covers play a significant role in case of sicknesses. Some people are employed by the government and are paid every month. Others involve themselves in businesses where they can make profits and have financial backups. Saving and increase in government debt are some of the consequences seen among patients in Japan and the United States (Koeckert et al., 2019). Since access to healthcare is based on one’s level and access to income, patients who come from poor backgrounds can be able to save the little they have for other needs. This is because the government provides free health services to the less fortunate. The retired employees can use the insurance when old and be able to cut off more expenses. Savings ensure the financial security of patients and their ability to cater for emergencies. The government’s huge expenditure leads to the imposition of more taxes on citizens (Suzuki et al., 2020). Thus, patients will face a financial crisis as they may be asked to cater for their expenses.

Professional Communication

This refers to the ways of passing information to people one interacts with at the workplace. In a hospital setting, the language used should be discrete, clear, and timely. Honesty must be upheld to create trust with patients so that they can receive better treatment. The doctors must keep the patients’ information private and secure. This will lead to better coordination among the various departments hence the improvement of health care services.

Conclusion

In conclusion, healthcare financing is critical in the access of medical services to citizens in both countries. The similarities and differences in the above countries have been discussed. The coverage for medications in these nations among children, the employed, and the retired have been considered. The requirements one must fulfil in order to see a specialist and the preexisting conditions for the patients have also been discussed. Financial implications that can either be positive or negative can also be predicted. An increase in savings among patients implies an excellent financial picture where most patients can have money to cater for other emergencies. This can help save lives leading to better lifestyles without more stress.

References

Bielecki, A., & Nieszporska, S. (2019). Analysis of healthcare systems by using systemic approach. Complexity, 2019, 1-12.

Koeckert, M., Grossi, E., Vining, P., Abdallah, R., Williams, M., Kalkut, G., Loulmet, D., Zias, E., Querijero, M. & Galloway, A. (2019). Ninety-day readmissions of bundled valve patients: Implications for healthcare policy. Seminars in Thoracic and Cardiovascular Surgery, 31(1), 32-37.

Suzuki, T., Iwagami, M., Hamada, S., Matsuda, T., & Tamiya, N. (2020). Number of consulting medical institutions and risk of polypharmacy in community-dwelling older people under a healthcare system with free access: A cross-sectional study in Japan. BMC Health Services Research, 20(1).

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NerdyTom. 2022. "Healthcare Financing Impacting Patient Outcomes." October 9, 2022. https://nerdytom.com/healthcare-financing-impacting-patient-outcomes/.

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NerdyTom. (2022) 'Healthcare Financing Impacting Patient Outcomes'. 9 October.

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