Research Paper on Healthcare Financing

Nurses need to understand the issues related to health care financing, including the health care policies and initiatives designed and enacted at the local and national levels of government, which affect the health care policing and performance as a whole. Therefore, as a patient advocate, a professional health care practitioner needs to work with patients and their families to enable them to access the available resources and meet their healthcare needs.

A: Comparison of U.S healthcare System Germany, Great Britain, Japan, or Switzerland.

There are many differences and few similarities in the United States healthcare system and other advanced industrialized countries such as Japan, Britain, Switzerland, and Germany. However, it is also important to note the United States healthcare system is quite unique and distinct from the other healthcare systems. The comparison will focus on a single country, Switzerland, in which the author is going to compare the healthcare system between the United States and the selected country. Unlike most of the other industrialized countries, the United States does not have a uniform or universal healthcare system, except the attempts recently to enact legislation that would mandate health care insurance for every individual in the country (Kane, 2012).

1. Comparison between healthcare systems for Children, Unemployed People, and Retired People

Access to health care premiums in the United States is experienced with many challenges including the rising health care premiums. For instance, between 2005 and 2015, the health insurance premiums in the United States increased by approximately 61% for every household. However, the workers contribution increased by approximately 83% in the same period (Chaufan, 2016). As a result, many people have not been able to access health insurance premiums as compared to Switzerland. According to Chaufan (2014), many children in the United States are still uninsured and the same with unemployed and retired people. The United States spends more than Switzerland in the healthcare system and yet millions of people still do not have the healthcare coverage; thus, they are unable to meet their healthcare needs. Unlike the United States where insurance is provided by the employers, Switzerland provide its people with the opportunity to choose which insurance coverage plan they wish to purchase and able to afford (Chaufan, 2014).

People in Switzerland have the freedom to choose the plans that can help them meet their healthcare needs; thus, most people are insured including children, unemployed, and retired persons. The case is different in the United States where people are stuck with the insurance coverage plan selected by their employers, which also ends as long as the person retires or leaves the organization. Children in Switzerland benefit from the low premiums provided by the sickness funds that enable dependent children to get insurance coverage as well, which is not the case in the United States (Chaufan, 2014). Therefore, most of children, unemployed, and retired people are uninsured because the largest share of coverage is covered by the employers. Unlike the United States where premiums vary with age, the Switzerland healthcare system provides its people with the standardized and subsidized rates.

In Switzerland, there are no deductibles for children below 18 years (Majette, 2011). Everyone from the age of 25 years to 75 years pays the same rates and the government helps them pay the coverage through subsidies, which is not done in the United States. Furthermore, the Switzerland healthcare system offers people the basic mandated coverage that one must pay to purchase an insurance, which is much robust, comprehensive, and affordable than it is in the United States. For instance, a maximum deductible allowed in Switzerland is approximately $2,500 as compared to the United States where it can go high as $7,100 per year (Kane, 2012). In Switzerland, approximately 99% of its citizens are insured; compared to about 60% of the United States insured (Reid, 2012). The disparity in the average health care policy is quite large between the United States and Switzerland. There are many reasons that can explain the rising cost of premiums in the United States; however, it still does not justify lack of quality and affordable for millions of Americans who are unemployed and retired people. Most of the retirees in the United States struggle to live a sustainable life, which is quite different in Switzerland. In Switzerland, retirees receive enough funds to enable them live a comfortable and sustainable life (Reid, 2012). Although, both United States and Switzerland have the social security program that helps the elderly and the disabled; however, retirees in Switzerland find it more comfortable because they are able to go about their normal businesses and daily activities since they have enough funds.

a.) Coverage for Medications

The coverage for medications in the United States is mainly provided by the employer, which is uneven in most cases (White, 2013). The uneven insurance coverage usually leaves the poor and minorities disadvantaged. According to Kane (2012), the insurance coverage in the United States vary with the wage level; therefore, organizations with higher proportions of low-wage workers are less likely to provide its workers with the insurance coverage as compared to those that have low-proportions of low-wage workers. Despite the fact that the healthcare insurance coverage is employer-based in the United States, many full time employees are not accessed to insurance premiums (Majette, 2011). However, this has been significantly reduced by the enactment of the Affordable Care Act. The situation is quite different in Switzerland as insurance coverage is provided by the private entities in collaboration with the government. People purchase their choice of insurance plan and the government provides subsidies to enable everyone access quality health care services. Therefore, unlike the United States where coverage for medications is a responsibility of the employers, people in Switzerland have a choice and freedom to choose the plan they desire and suit their medical needs (Chaufan, 2016). Although the United States, under the ACA also offers almost the same subsidy program to people, but it is not effective and efficient as it is in Switzerland.

b.) Requirements to get Referral to see a Specialist

A referral specifies what kind of care a patient needs (Mehrotra et al., 2011); for instance, it identifies and states whether one needs to see a specialist or the kind of examination or treatment the patient needs. The requirement to get a referral in United States is quite tedious and tiresome than it is in Switzerland. Although many people in the United States may need referrals, but the process of obtaining it has been described as being long standing source of frustrations among the patients and physicians (Mehrotra et al., 2011, p. 42). In Switzerland it is quite different; there is a free choice of physicians and other healthcare specialists. Unlike the United States where is gatekeeping system that limits people from accessing specialists, the Switzerland does not bar anyone from seeing the doctors of their choice when they are in need to. This disparity can be explained by the socioeconomic segregation in the United States. As mentioned in the previous section, the United States healthcare insurance premium plans vary with wage-level. Therefore, most of the minority, poor, dependent children, and unemployed are uninsured.

c.) Coverage for the Pre-existing Conditions

Although the United States healthcare specialists are considered among the best and effective in the world, but the treatment process is associated with negative remarks such as inequitable and neglects primary and preventive care (Reid, 2012). The general overview of U.S approach to its health care is poorer as compared to Switzerland. Despite the improvements brought about by the ACA, the United States healthcare system still experience challenges including lack of coverage for the pre-existing condition (White, 2013). The discussion emerged recently between the democrats and the republicans on whether the pre-existing conditions should be included in the latest version of GOP health care bill. However, for many years the United States healthcare insurance coverage plans have not considered the pre-existing conditions, until the introduction of the ACA. The proponents of the new GOP health care bill claim that the pre-existing conditions are included in the new bill and that despite the changes the insurers would still be required by law to provide insurance services for anyone regardless of the pre-existing condition. However, this means that the insurance would need to charge higher premiums depending on the health status. This is different in Switzerland where the health insurance companies are mandated to provide insurance coverage to every person irrespective of the age or pre-existing conditions (Chaufan, 2016). Further, the Switzerlands government that acts as the watchdog for the private insurers prohibits the insurance companies from profiting from the sales of the basic, mandatory health care plans offered to every citizen.

2. The Financial Implications for Patients

The healthcare insurance plans in Switzerland are provided by the private organizations but with the supervision of the government to avoid overexploitation of patients or users as it happens in the United States (Reid, 2012). There are various financial implications for the patients who purchase the health care insurance plans in the United States and Switzerland. First, due to increased cost of insurance coverage, most of patients in the United States spend a lot of money to purchase the cover. Although is provided by the employer, but it means that the wage-level has to be reduced to meet the insurance coverage. The increasing high cost of insurance has left approximately 30% of Americans from the low income class uninsured today (Chaufan, 2016). Many people, especially the minority and poor people are unable to get insurance coverage because the cost is very high. This is quite opposite in Switzerland where almost 99.5% of its citizens are insured today (Chaufan, 2014).

The cost of the insurance coverage is very affordable to many people irrespective of the age or income level. The coverage cost for an insurance plan in the United States is almost double the cost in Switzerland. For instance, the average premium in Switzerland is approximately $243 per month whereas in the United States the average premium is approximately $536 per month (Kane, 2012). The maximum premium plan for a single coverage in the United States can cost as much as $6,251 and employer-family coverage can cost as much as $17,545 annually (Rosman & Apfeld, 2013). In Switzerland, the average premium can cost approximately $2,000 annually (Roy, 2011). Secondly, the high cost of insurance coverage in the United States increases the systemic challenges; thus, it does not guarantee quality service delivery to the users.

The United States is among the top leading countries with the most specialized workforce of healthcare practitioners but it is a challenge for many patients to access quality health care due to inadequate specialists. Despite that the government spends the highest allocation in the healthcare system (17.6% of GDP for the U.S and 10.8% of GDP for Switzerland); the quality of healthcare delivery is still a great challenge (Kane, 2012). Switzerland on the other hand is considered to have one of the best healthcare delivery services in Europe. Although Switzerland spends almost half of what U.S spends on healthcare system, it has enough manpower to meet the needs of patient...