Health systems in each country are designed to meet their population’s health needs through medical services. Citizens’ health has the most significant impact on their well-being and quality of life. However, the features of some systems do not make it possible to receive the necessary services to the entire population equally. As patient advocates, nurses need to understand the system’s problems and specifics, particularly its financial implications for the public, and look for ways to improve it. Comparing the strategies of different countries helps better analyze existing challenges and find their benefits, which can be introduced to strengthen own services. The current paper considers the U.S. and Japanese health care systems, including access issues for children, the unemployed, and retirees, insurance and referrals features, and the patients’ financial burden.
Access to Healthcare
The American and Japanese systems use entirely different approaches to service coverage, which determines their availability. In particular, there are many private and public insurance programs for various groups of the population in America. Some programs have specific requirements for citizens to participate, for example, Medicare and Medicaid (Ruggles et al., 2019). Japan, in turn, uses universal health and insurance system in which all citizens must be registered (Ruggles et al., 2019). Differences in approaches suggest that the complexity of the American system makes health services less accessible than in Japan.
Vulnerable populations suffer in the case of unequal access to health care. Therefore, an analysis of the availability of services for children, the unemployed, and retirees will help understand the countries’ systems. According to research by Ehara (2018) and Kang et al. (2022), children’s medical expenses in Japan are covered by subsidies allocated by local government bodies, which make services for them free. Providing insurance for American children is more complex – parents must pay for it, and the prices are usually high. There is also an option to participate in Medicaid and Children’s Health Insurance Program (CHIP), which makes insurance more accessible for low-income families (Twomey, 2019). However, the number of children eligible for programs is reducing, limiting access to health care. As a result, health services are more accessible to Japanese children than Americans.
Providing services for the unemployed and people in retirement is an essential and challenging task. In Japan, these groups are part of the National Health Insurance system, which covers most services costs, and citizens pay nearly 30% for them (Matsuda, 2020). In some cases, the older population pays even less – 10%. In the U.S., insurance opportunities are determined by the size of income and family, not employment status. As previously mentioned, low-income families can participate in programs making insurance more affordable. Retirees in America can receive insurance through a job-based plan or purchase, the possibilities of which also depend on income (“Health coverage,” n.d.). Given that the enrolment scope of the U.S. programs for low-income families is falling, American unemployed and retirees have less access to health care than Japanese ones.
Coverage for Medications
Medication is an integral part of the treatment of many conditions. However, often the high cost becomes an additional barrier to the availability of health services. In particular, a significant part of American citizens believes that prescription drugs are too expensive. Public and private insurance programs cover about 85% of the cost of drugs (Kurani et al., 2022). Nevertheless, for a third of the population in the U.S., the high cost is a reason not to take medications (Kurani et al., 2022). At the same time, studies have found that drug prices in the U.S. are nearly four times higher than in Japan (Renfrow, 2019). The drug coverage scheme in Japan is the same as other services – a single insurance system provides a significant part of the cost, and about 30% is paid by citizens (Matsuda, 2020). As a consequence, drugs are also more available in Japan.
Requirements for Referrals
Visiting specialists can require a referral, and this procedure may differ in various countries. Receiving a referral to another physician other than a primary care physician (PCP) in America requires a prior appointment with a PCP who must confirm the need for a visit to another specialist (Levy, 2021). After approval, the patients need to check with their insurance plan – the doctors they can contact should be in the network of the existing program. In some cases, it will be helpful for the patients to contact their insurance agency to confirm the referral is approved. Only after citizens ensure that insurance covers the costs can they reach the necessary specialist and make an appointment. The referral may not be mandatory if it is possible to pay independently. However, given the high cost of services, citizens rarely have the opportunity to pay independently.
Japan’s health care system also offers a more straightforward procedure for visiting various specialists. Patients can contact any hospital and specialist they wish and do not need to receive a referral and approve it in the insurance system. However, some large hospitals and centers may require an additional fee from citizens without a referral (Matsuda, 2020). If there is a referral from a doctor, it must be provided during registration. Such features make the process of appointments with specialists faster.
Coverage for Pre-existing Conditions
An important issue in obtaining insurance is the current condition of the patient and the presence of diseases. It may not be profitable for insurance agencies to pay for patient care from pre-existing conditions to plan acquisition. For example, in the United States, old insurance plans do not provide payment for such diseases. However, all Marketplace plans should now cover the pre-existing condition and not charge additional fees for them from users (“Coverage,” n.d.). In Japan, there are also no restrictions on obtaining health insurance for patients with pre-existing conditions, and the national system covers the necessary expenses (“Health insurance,” n.d.). Thus, the treatment of diseases that the patient had before receiving insurance is available in the USA and Japan.
Financial Implications for Patients
Considering the described features of the two systems, one can distinguish financial implications for patients in these countries. The first implication for US patients is that medical services are costly, and buying insurance is a severe burden for citizens. The second consequence is that despite the work of programs, which should facilitate access to services, their cost exacerbates existing inequalities, and low-income groups do not receive the necessary care. In Japan, the key implication is that a single system promotes equality in receiving services, making them affordable to different groups of patients. Another consequence is that children can receive a subsidy and, as a result, free services, which contributes to the better health of the nation and lower health care costs in the future. Each system strives to provide quality services, but their features suggest that healthcare is more affordable in Japan.
Thus, this paper examined the features of health care systems in the United States and Japan. The study found that for vulnerable groups such as children, retirees, and the unemployed, care is more accessible in Japan. Moreover, a universal health system in this country also makes it easier to cover the cost of medicines and receive a referral. These issues are more complicated in the United States, and high costs can be a significant obstacle to ensuring health.
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