Japan Single Payer powerpoint
You are running for US Congress in your home congressional district. Based on your term paper conclusion Make a 5-10 Slide presentation for a TV advertisement to convince voters of you position on Health Care Insurance Coverage.
Term Paper is attached below
Running Head: SUMMARY 1
SUMMARY 2
HCM680
Health Insurance and Managed Care
Instructor: Richard Gammans PhD MSM
Sonja McDonald
Term Paper
Part 2: Conclusion and Recommendation
Spring 2020
Managed care in the united states started in the 19th century when a few physicians in many cities in the united states began giving prepaid medical care to members of the unions, fraternal order, and many other workers’ associations. On the other hand, in Japan, the health insurance system started to develop after the Meiji restoration when the western medication was introduced. There was a difference in payments where those enrolled in employee health insurance paid the average amount for the first physician and the dependents.
In U.S. The provider should determine the party with which it will contract. Collect relevant information about contracting. Initiate the contract with the companies that are contracting. In Japan They start by defining the scope of care they are providing. Identification of the beneficiaries is then made. Identification of the type of privileges that the provider will offer. In U.S. The employer makes payments to the insurance firm in which when the employee has received services. The physician claims it from the insurance firm. On the other hand, Health insurance is mandatory in Japan, and those that do not provide the card do not receive medication
The general outcomes in the united states health are far lower than the other industrialized countries, regardless of it being a wealthy country. However, life expectance has increased at a small margin. Japan among the industrialized countries has achieved a lot of progress in terms of the healthcare systems. Cases such as heart attacks have been on control. Many people have been saved, including those involved in accidents. In Japan, healthcare insurance is a mandatory practice where some of the insurances offer preventive services that also include: the inpatient hospital cares outpatient medical care, mental health is also catered.
U.S should implement single player healthcare system. The current healthcare system has a lot of issues. The country is spending too much on healthcare compared to other nations, the country has remained to have a very low life expectancy and has poor health outcomes compared to these nations such as Japan (Douthit et al., 2015). This complex network insurance program is a total waste because of the high administrative costs connected to it plus the lack of control in prices is another issues with the system. Another major issues with our healthcare system is inequity because it lacks a proper universal healthcare. The ACA has brought some important advantages towards expanding and improving the health insurance coverage. However, this insurance still leaves 30 million Americans as uninsured (Andrea & Christopher, 2020).
Implementing a single payer healthcare system will allow everyone to have health insurance under the same insurance plan and access to the necessary services in the field of healthcare. Individuals will still have the chance of choosing where they want or they are comfortable to receive care (Sakamoto et al., 2018). This system is like more of Medicare and U.S. refers it as Medicare-for-all. This system will address some of the issues that the country is currently experiencing. This coverage will be a step towards equality most especially for the underinsured or the uninsured individuals in the country (Andrea & Christopher, 2020). There will be minimal utilization of funds hence it will control wasteful spending by reducing administrative costs. In addition, a single payer strategy consists of more incentives for direct healthcare spending to public health strategies. Transitioning to a single payer system there might be potential tradeoffs such as length waiting time as well as restricted availability of specific healthcare services.
References
Andrea, S. & Christopher, (2020). Single payer healthcare: Pluses, minuses, and what it means for you. Retrieved from https://www.health.harvard.edu/blog/single-payer-healthcare-pluses-minuses-means-201606279835
Douthit, N., Kiv, S., Dwolatzky, T., & Biswas, S. (2015). Exposing some critical barriers to health care access in the rural USA.Public health,129(6), 611-620.
Sakamoto, H., Rahman, M., Nomura, S., Okamoto, E., Koike, S., Yasunaga, H., … & Palmer, M. (2018). Japan health system review. Running Head: MANAGED CARE
1
MANAGED CARE
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Attachment 1
Health insurance and managed care
Instructor: Richard Gammans PhD MSM
Sonja McDonald
Term paper
Part 1 Outline
Fall 2020
Due September 13, 2020
Instructions:
1. Select one of the following Single Payer countries: Japan. Other countries can be used with Instructor permission
2. Make bullet-point notes regarding necessary (in your opinion) contrasting features for the United States and your selected Comparator Country
3. Due September 13, 2020
TOPIC
UNITED STATES
COMPARATOR COUNTRY(JAPAN)
History of Managed Care and Health Insurance
Managed care in the united states started in the 19th century when a few physicians in many cities in the united states began giving prepaid medical care to members of the unions, fraternal order, and many other workers’ associations. The associations that were participating in the medical care had each member pay a small amount of money to physicians. Then they gain access toa wide range of health care services which the physician can provide. In the 20th century, the workers in companies such as mining, railroad, and lumbering companies came up with their own medical services.
They contracted with the medical groups that provided care for their workers. It became widespread during the great recession where the employers and employees adopted Medicare services. In the 1970s, the federal government and other private firms started encouraging to join healthcare groups that pay for medical assistance in advance. The growth of prepaid healthcare services was slowly growing despite encouragement (Douthit, Dwolatzky, & Biswas, 2015). Coming to the 1980s, many employers turned to prepaid services for their workers until the 1990s when it increased significantly. Today many of the Americans are covered by either the private and the government-sponsored managed care.
The health insurance system started to develop after the Meiji restoration when the western medication was introduced (Sakamoto et al.,2019). Therefore, the healthcare insurance was not established until 1927, where the first health insurance for employees was created in 1961. almost every individual in japan got insured by universal health insurance (Sasaki, Izawa & Okada, 2015). There was a difference in payments where those enrolled in employee health insurance paid the average amount for the first physician and the dependents.
In contrast, those who were enrolled in the health insurance sponsored by the government paid 50% of the required fee. These enabled them to receive the services that they required plus the medications. In the 1980s, due to the changes in healthcare levels, the insurance systems were harmonized so that they could control the cost of service and medicine. Since then, the health insurance system has been well established in Japan.
Health & Benefit Plans
There are some basics that an individual can benefits from the insurance scheme though it varies from one state to another.
They include benefits include
outpatient care services and treatments in inpatient care services.
Care before and after the child has been born. expenses are about the prescription of drugs.
Mental health care services, including psychotherapy and counseling of the mental health patients.
Laboratory tests
Pediatric services such as dental and visual health care services
Preventive care services include vaccination, screening, counseling, and management of chronic diseases (Dieleman et al.,2017).
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In Japan, healthcare insurance is a mandatory practice where some of the insurances offer preventive services that also include:
the inpatient hospital cares
outpatient medical care, mental health is also catered.
Insurance caters for the drug prescriptions by the physicians, home healthcare services and dental healthcare services
Supplemental Insurance Available or Needed?
Medical supplementation is useful. For instance, when a person has retired, you realize that finding the cash to add to insurance cash is very difficult. It then becomes a wise decision to have a Medicare supplement plan, which may fill some gaps and put you at a better place during a crisis. The medical supplements are essential because the regular insurance does not cover you for everything, while Medigap is slightly higher in terms of cost, but it gives full coverage. Medical supplements are also better if you are admitted to the hospital for more than 60day with the regular insurance scheme. One is supposed to start paying some fee; therefore, supplements are essential as they also can cover co-payments and deductibles.
In Japan, supplementary health insurance is not needed because the systems of insurance in japan cater very well to its clients’ requirements. Still, for the foreigners, it is necessary (Sakamoto et al.,2019).
Provider Contracting and Credentialing
The provider should determine the party with which it will contract.
Collect relevant information about contracting
Initiate the contract with the companies that are contracting
obtain the credentials such as the 10-digit identification number called national provider identifier and the tax identity number. (Webber, et al.,2019).
Complete the application and keep on looking at the status of registration.
contract rates and terms are then reviewed.
objectionable conditions, if any, should be negotiated.
The signing of the contract
Finally, the contract should be renewed and updating of the fee.
They start by defining the scope of care they are providing
Identification of the beneficiaries is then made.
Identification of the type of privileges that the provider will offer.
Assessment of the qualifications of the provider.
Request for the benefits that you as a provider you need to have.
Obtain the current licenses
Development of a system that stores information.
Provider Payment
The employer makes payments to the insurance firm in which when the employee has received services. The physician claims it from the insurance firm
Health insurance is mandatory in Japan, and those that do not provide the card do not receive medication
Utilization and Quality Management
The united states have the best facilities, but currently, there has been a high cost of seeking medication. The medical insurance not covering entirely the medical cost means poor utilization and low quality of services compared to many industrialized countries (Dieleman et al.,2017).
Japan has a high quality in terms of the facilities with the best medical insurances. They have utilization levels that make both the healthcare services and the insurance systems the best among the industrialized countries (Sakamoto et al.,2019).
Governance & Administration
Governance and administration in the health care in the federal government’s duty, but the current government have placed in it a lot of politics that is affecting healthcare services.
The government has made the medication in japan free enabling the Japanese citizens to receive free medical services that have led to increased life expectance.
Overall Health Outcome
The general outcomes in the united states health are far lower than the other industrialized countries, regardless of it being a wealthy country. However, life expectance has increased at a small margin.
Japan among the industrialized countries has achieved a lot of progress in terms of the healthcare systems. The expectance rates have been very high with where many of the diseases have found the proper address. Cases such as heart attacks have been on control. Many people have been saved, including those involved in accidents. The health care services are highly affordable.
References
Dieleman, J., Campbell, M., Chapin, A., Eldrenkamp, E., Fan, V. Y., Haakenstad, A., … & Reynolds, A. (2017). Evolution and patterns of global health financing 19952014: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries.The Lancet,389(10083), 1981-2004.
Douthit, N., Kiv, S., Dwolatzky, T., & Biswas, S. (2015). Exposing some critical barriers to health care access in the rural USA.Public health,129(6), 611-620.
Sakamoto, H., Rahman, M., Nomura, S., Okamoto, E., Koike, S., Yasunaga, H., … & Palmer, M. (2018). Japan health system review.
Sasaki, T., Izawa, M., & Okada, Y. (2015). Current trends in health insurance systems: OECD countries vs. Japan.Neurologia medico-chirurgica,55(4), 267-275.
Webber, B. J., Burganowski, R. P., Colton, L., Escobar, J. D., Pathak, S. R., & Gambino-Shirley, K. J. (2019). Lyme disease overdiagnosis in an extensive healthcare system: a population-based, retrospective study.Clinical Microbiology and Infection,25(10), 1233-1238.
