Access by Children, Unemployed and Retired People

Nurses, as patients’ advocates, have a duty of working with patients and their families in their quest for optimal healthcare provision. As such, they have an obligation of understanding how different healthcare systems across the globe work in a bid to maximize the potential of healthcare resources that meet their health care needs (Thomson, Osborn, Squires, & Reed, 2011). Different country’s health care issues such as healthcare financing, healthcare policies and initiatives, equitable access and coverage of health care by different groups of the population are critical to this end. This paper will seek to compare the health care systems of the US and Germany with regard to the foregoing healthcare concerns.
Access by Children, Unemployed and Retired People

In the U.S. children access health care through their parents Medicaid insurance policies as well as through the Children’s Health Insurance Program (CHIP) [The Commonwealth Fund, 2018a]. Children can also access health care through private health insurance schemes of their parents. Unemployed people who constitute a big proportion of the US uninsured people access health care through the federal government’s funding of community health centers which basically offer primary care. Retired people who are mostly senior citizens access healthcare through Medicare programs [The Commonwealth Fund, 2018b].

In Germany, children are able to access health care through their parents’ health insurance schemes which can either be private health insurance or government health scheme; German health insurance. Dependents including a non-working spouse and children and retired people are included on the employed person’s address as long as they are registered with the government’s long-term nursing care scheme making them able to access healthcare at no extra charges on the same [Expatica, 2018]. Retired people can also access health care through their own private health insurance with the government regulating the same to prevent exploitation through premium increases as they age. Unemployed people make their contribution to statutory health insurance with regard to their unemployment entitlements with those unemployed for a long period being contributed for by the government [The Commonwealth Fund, 2018a].

The US Affordable Care Act (ACA) requires private health insurance including small-group market to cover critical health services such as emergency services, mental health services, prescription drugs, drug abuse, and mother and child care services (Singh, 2015). Medicare covers hospitalization for post-acute illnesses, prescription drugs and physician services with the program removing cost-sharing for most preventive services. While Medicare does not cover long-term care, Medicaid covers it besides offering a broader range of health care services such as physician services, hospitalization and other services that differ by state. Cost-sharing and out-of-pocket payments are sometimes required depending on insurance policies took but the ACA allow cost-sharing subsidies for people living below the federal poverty level to allow universal coverage. By and large, individuals can be covered by either or both public and private health insurance fashioned in different ways to cater to different healthcare needs (Squires, & Anderson, 2015).

Coverage for Medications

In Germany, German health insurance covers health care services at primary care level including in- and out-patient services, dental services, rehabilitation, physical therapy, prescription drugs, mental health care, and hospice and palliative care. Preventive services covered under the same include basic immunization, dental checkups, cancer screening, and child checkups [The Commonwealth Fund, 2018a]. Private health insurance however covers a wider range of healthcare services than state insurance [Expatica, 2018]. Long-term care insurance (LTCI) covers home care services while cost-sharing and out-of-pocket spending are sorts for specific healthcare services. However, children below 18 years of age are exempt from cost-sharing [The Commonwealth Fund, 2018a].

Patients under the Germany healthcare system are free to choose their own health care practitioners including General Practitioners and another specialist. There is no requirement for a patient to first see their primary doctor before being referred to a specialist. Just like in Germany, patients in the US are free to choose a specialist without necessarily having the requirement to register with a primary care practice. However, this depends on the type of insurance plan patients have undertaken. For instance, some managed-care plans such as health maintenance organizations (HMO) demand a referral from a primary health care provider to see a specialist and by extension bounds patients’ specialist choices. Broader and direct access is allowed by Preferred provider organizations (PPOs). Patients with either private or public insurance are entitled to see a specialist [The Commonwealth Fund, 2018b].
Coverage for Preexisting Conditions

In Germany, preexisting conditions such as chronic illnesses are covered under the safety nets program in which the annual cap on cost –sharing is lowered from 2% of the households’ income to 1% so long as patients evidence that they attended screening procedures and concealing prior to falling ill. In the US, the Pre-existing Condition Insurance Plan (PCIP) covers the US citizens and those legally in the US with a pre-existing condition as well as those who have been denied coverage due to their health condition. However, this cover is only for enrollees and not family members and other dependents (Blumenthal, & Collins, 2014).

In Germany, income levels dictate the government health insurance contributions. Even as such, advantages and benefits with regard to health care services are by and large distributed according to need. Doctors and other specialist treat anyone with requisite statutory health insurance. Private health insurance contributions and benefits depend on risks meaning that older Germans are liable to pay more than younger people. Moreover, in-patients are charged more for services such as meals since most insurance companies do not cater for such costs (Busse, Reinhard & Blümel, Miriam, 2014).

Access to see a Specialist

Under the ACA, the US government is keen to see that healthcare access and coverage disparities are addressed. As such most government-led insurance schemes such as Medicare and Medicaid are structured in ways that favor the income levels of different people (Bethell, 2011). Medicaid and CHIP are structured with policies keen to reduce adverse financial impacts especially for low-income households while Medicare reduces the financial implications to the aged and the disabled. The federal government has dedicated the expansion and financing of Medicaid currently but financial responsibility is bound to roll back to the states by 2020.

Conclusion

Both Germany and the US healthcare systems are complex and multifaceted with patients having different options to access and cover their healthcare needs. Both healthcare systems have public and private health insurance schemes. However, while the US’s public insurance is federal and state-run with a view to achieving universal coverage; Germany’s public insurance is run and managed by the provider and self-governing associations within sick funds with the government only overseeing the same through the Federal Joint Committee. In both countries, private insurance is government regulated. By and large, Ridic, Gleason, and Ridic, (2012) assert that both governments take healthcare access, coverage, financial implication of its citizens seriously and have endeavored to develop specific policies to govern the smooth and effective running of the same.

References

Bethell, C. D., Kogan, M. D., Strickland, B. B., Schor, E. L., Robertson, J., & Newacheck, P. W.(2011). A national and state profile of leading health problems and health care quality for US children: key insurance disparities and across-state variations. Academic Pediatrics, 11(3), S22-S33.

Blumenthal, D., & Collins, S. R. (2014). Health care coverage under the Affordable Care Act—a progress report.

Busse, Reinhard & Blümel, Miriam. (‎2014)‎. Germany; Health system review. European Observatory on Health Systems and Policies. Available from https://www.who.int/iris/handle/10665/130246 Expatica (2018). The German healthcare system: A guide to healthcare in Germany. Available from https://www.expatica.com/de/healthcare/Your-guide-to-the-German-healthcare-system_103359.html

Ridic, G., Gleason, S., & Ridic, O. (2012). Comparisons of health care systems in the United States, Germany, and Canada. Material socio-medica, 24(2), 112.

Squires, D., & Anderson, C. (2015). US health care from a global perspective: spending, use of services, prices, and health in 13 countries. The Commonwealth Fund, (15), 1-16.

Singh, D. A. (2015). Essentials of the US health care system. Jones & Bartlett Publishers.

Thomson, S., Osborn, R., Squires, D., & Reed, S. J. (2011). International profiles of health care systems 2011: Australia, Canada, Denmark, England, France, Germany, Iceland, Italy, Japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States.

The Commonwealth Fund (2018a). International Health Care System Profiles; German Health Care System. Available from https://international.commonwealthfund.org/countries/germany/

The Commonwealth Fund (2018b). International Health Care System Profiles; U.S. Health Care System. Available from https://international.commonwealthfund.org/countries/united_states/