Access to health care in United States has been an issue of debate since there lacks a uniformed health system. The health care system in U.S. is a hybrid one whereby the services are provided by combining a national health service with a single-payer national health insurance system and multi-payer universal health insurance fund (DPE Fact sheet, 2018). In U.S health care is costly, which limits its accessibility to people who are uninsured. Children from poor socioeconomic backgrounds have difficulty accessing healthcare especially since the Children’s Health Insurance Program funding has been inadequate. However, with the Patient Protection and Affordable Care Act (PPACA or ACA in short) that was passed in 2010, there has been significant changes with the use of vouchers and tax credit from Medicaid. The unemployed are now able to access quality health care through the public program of Medicaid, which is improving their health outcomes. The elderly and retired persons also benefit from the implementation of ACA with increased access to outpatient care and reduced costs for long-term management. The U.S. healthcare system has improved over the last few years in accessibility although it still ranks poorly when compared to other countries.
Comparing the American health care system with that of Germany brings out major differences in the delivery and accessibility of quality health care. Germany is an industrialized country that uses a universal multi-payer health care system that is combined with statutory health insurance. The government spending on health is lower at 10.7 % of GDP (in 2005) and the patients are able to access the health services they require conveniently. It is mandatory to have health insurance in Germany which caters for costs accrued for medication and treatment (Blümel & Busse). 92% of Germany’s population, has medical insurance cover under a Statutory Health Insurance (SHI) plan which exempts children under 18 years but still provides health care services to them under family cover (Bormann & Swart, 2013). The unemployed contribute to the SHI in correspondence to their unemployment entitlement and are covered at a proportionate amount (Blümel & Busse). The retired people have access to health services due to their contributions and some transfer to private insurance that covers specialized health services as they age.
U.S. healthcare system covers medication costs, including pre-approved prescription drugs for people who are under insurance. However, it is important for people to check the drug list on the preferred insurance plan to ensure all the medication they need is approved. In Germany, patient’s co-pay for the medication in affordable plans in the public health insurance scheme. Medication is available at pharmacies and the insurance cover dictates the amount that is covered and that which the patient has to pay.
Regarding referrals, patients in the U.S.A get referred by their primary healthcare provider to a specialist when their condition requires in depth care. An appointment with the specialist is required and the patient has to present the signed and dated referral form from their practitioner. All information about the patient and their condition and treatment is necessary for the specialist. On the other hand, in Germany the general practitioner has to communicate with the specialist or consultant before a patient gets to be referred. Failure to do so attracts additional charges from the patient. The communication includes all relevant information about the patient such as diagnosis and treatment.
In terms of the pre-existing conditions, Germany requires that a patient undergo necessary screening and tests in order to receive treatment. The public insurance program decides what costs to cover which render a certain percentage of the population to prefer private insurance. With private insurance cover, which is affected by age, older individuals contribute a larger proportion of their medical expenses. Those with pre-existing medical conditions are also required to contribute more for their treatment as compared with healthy people (NCBI) In comparison, U. S health care systems also cover pre-existing conditions and those insured are guaranteed treatment despite the controversy surrounding the issue. Those newly enrolled into insurance cover are required to disclose all relevant information concerning past medical history and any pre-existing condition.
The cost of healthcare in USA has increased over the years with rates that are above the pay rates as well as inflation. However, the insurance system offering co-paying options has fallen leaving patients with a great burden of medical costs. Workers also have higher annual deductibles as well as premiums for their medical insurance. Therefore, more people are still having medical debts despite having insurance due to increased healthcare costs. In comparison, the healthcare system in Germany works on distribution of resources to the sick through the ‘sickness fund’. Patients are able to access healthcare services through co-payer plans. In Germany, due to the multi-payer system, most medical costs are covered by insurance. There is also the competitive aspect of all the insurance providers which enhances the number of benefits a patient can enjoy. Therefore, the patient’s financial capacity is not greatly affected by their health care needs.
Blümel, M., & Busse, R. (n.d.). Compulsory Health Insurance in Germany – Germany Health Insurance System. Retrieved from http://www.germanyhis.com/compulsory-health-insurance-germany/
Bormann, C., & Swart, E. (2013). Utilization of Medical Services in Germany—Outline of Statutory Health Insurance System (SHI). Health Care Utilization in Germany, 29-41. doi:10.1007/978-1-4614-9191-0_3
DPE. (2018, December 3). The U.S. Health Care System: An International Perspective — DPEAFLCIO. Retrieved from https://dpeaflcio.org/programs-publications/issue-fact-sheets/the-u-s-health-care-system-an-international-perspective/
Greß, S. (2007). Private Health Insurance in Germany: Consequences of a Dual System. Healthcare Policy | Politiques de Santé, 3(2), 29-37. doi:10.12927/hcpol.2007.19389