HIMS 655 Healthcare System Discussion Solution

HIMS 655 Healthcare System Discussion

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HIMS 655 Healthcare System Discussion

Hi, please, read and contribute to peer discussions in 100 words minimum with at least 2 to 3 credible sources.

Peer 1:

The United States expects people to obtain and pay for their own medical insurance plans, either as an individual or through a group plan with an employer. The main exemption is on the off chance that they meet all requirements for qualification in one of the governmental health plans proposed to specific

people who meet certain pay, age, or handicap criteria. (Pulse 2019) This includes programs like Medicare, Medicaid, or the Veterans Health Administration. In comparison the Canadian national government gives subsidizing backing to medical services protection to common state run administrations as long as

the region follows guidelines illustrated in the Canada Health Act (CHA) of 1984.(Ridic et al 2012) This is then used to furnish all Canadian residents with health care coverage through the public medical services framework.

These two countries, because of proximity and opposing systems have been compared for years.

HIMS 655 Healthcare System Discussion

The pros and cons for the United States system include:

PROS

  A conventional health insurance plan, which allows unrestricted choice of health care provider and reimburses on a fee for service basis, presently covers less than 30% of all employees.

Private and public health insurance

Patients have free choice of doctor, but often choose based on whether that doctor falls “in-network” with their health insurance provider.

US does have the most advanced health care technology and care in the world, which means a patientlooking for care will find it within the US without a long wait list. Due to the advanced state oftechnology, patients have higher life expectancy and low infant mortality rate.

CONS

HIMS 655 Healthcare System Discussion

  Approximately, 16 % of the population is estimated to lack health insurance coverage at any point in time.

Significant expenses of Care.

The pros and cons for the Canadian system include:

PROS

  Patients do not participate in the reimbursement process, and reimbursement exclusively takes place between the public insurer (the government) and the health care provider.

  Canadian health care system offers national health insurance financed by taxes, private production of health care services, and regulated budgets and fees for health care providers.

CONS

HIMS 655 Healthcare System Discussion

  Recent studies found Canadian deficits in several areas including angioplasty, cardiac catheterization and intensive care. Waiting lists for certain surgical and diagnostic procedures are common in Canada. Nationwide, the average wait for treatment is 13.3 weeks. The average waiting time in more than 80% of the procedures is one third longer than Canadian physicians consider clinically reasonable.

  When government provides a product “free” to consumers, inevitably demand escalates and spending increases.

The universal health care system that provides coverage for all Canadian citizens limits that coverage to services provided by hospitals, medical practitioners, or surgical dental services provided in a hospital

Ridic, G., Gleason, S., & Ridic, O. (2012). Comparisons of health care systems in the United States, Germany and Canada. Materia socio-medica, 24(2), 112–120. https://doi.org/10.5455/msm.2012.24.112-120

The SGU Pulse. (2019, April 09). Comparing the US and Canadian health care system: 4 differences you need to know. https://www.sgu.edu/blog/medical/comparing-us-and-canadian- health-care-systems/

Peer 2:

HIMS 655 Healthcare System Discussion

The U.S healthcare system is a direct-fee system that relies heavily on private insurance plans rather than national health insurance, which has been adopted by many other western nations. U.S insurance is largely granted through an employer, or purchased out of pocket, with any additional medical costs not

covered by insurance requiring additional out of pocket costs. The Clinton Courier lists several pros to the U.S system such as quality healthcare services, due to the rigorous requirements the healthcare system has for healthcare providers, modern equipment, shorter waiting-lists, and adequate medical

resources and supplies (The Clinton Courier, 2020). However, they also list cons, some of these being the extremely expensive costs of medical care in the U.S, lack of pricing transparency, and often limited insurance coverage. Papanicolas et al. (2018) explain that one of the reasons why healthcare costs are so

high in the U.S is because of both high pharmaceutical and high administrative costs. These drive U.S healthcare costs to nearly double that of other high-income countries even when utilization rates are similar.

One of the high income countries mentioned above that we can compare the U.S to is Germany. I may have chosen Germany for this comparison simply because I studied abroad there for a short while after high school, but nevertheless the differences in the healthcare systems of Germany and the U.S are stark.

Germany, unlike the U.S, has a socialized healthcare system. Ridic et al. (2012) write that the German system is based upon a principle of social solidarity that obliges the government to provide a range of social benefits to citizens, such as healthcare. Although healthcare is only free to low income, elderly, or

those unable to work, the amount paid by average German citizens is still dramatically less than the U.S. Additionally, they add that patient cost sharing is minimal. Insurance premiums are collected through payroll tax deductions, coverage for certain conditions are mandated by law, and physicians in private

practice do not have any admitting privileges. Fund for Education Abroad (n.d.) notes that major pros of this system are no questions asked coverage for any covered health issues, no calculations about affording co-pays, no stress about taking emergency rides in an ambulance, and all around decreased stress

related to medical care. They do note some downfalls are medication policy that limits the prescription of non-over the counter pain killers, as well as dramatically lower paychecks for healthcare workers.

In my honest opinion, and I think we all know this, the U.S healthcare system is extremely flawed. Solutions like increasing taxes to pay for socialized medicine are not exactly easy pills to swallow but, I think the resulting decreased stress about coverage and costs of care are well worthwhile. No one should have to fear getting much needed healthcare treatment because they cannot afford it. Germany doesn’t have a perfect system, but their citizens have a much greater comfort level with healthcare costs than Americans, and that is something to work towards.

References:

Fund for Education Abroad. (n.d.). The Pros and Cons of German Healthcare. Fund for Education Abroad. https://fundforeducationabroad.org/journals/pros-cons-german-healthcare/

Papanicolas, I., Woskie, L. R., & Jha, A. K. (2018). Health care spending in the United States and other high-income countries. JAMA, 319(10), 1024. https://doi.org/10.1001/jama.2018.1150

Ridic, G., Gleason, S., & Ridic, O. (2012). Comparisons of health care systems in the United States, Germany and Canada. Materia Socio Medica, 24(2), 112. https://doi.org/10.5455/msm.2012.24.112-120

HIMS 655 Healthcare System Discussion

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