Organizational Systems and Quality Leadership

Task 3, SAT1-0517/1217

Name

University
ORGANIZATIONAL SYSTEMS TASK 3 2

Healthcare Financing
A1. Country to Compare

The country Identified for this case is Great Britain; the paper compares the healthcare system of

Great Britain to the U.S. healthcare system.

A1. Access

Access to healthcare in the United States seems to be more complex in relation to the

healthcare system in Great Britain. In the United States, a child is covered as long as the parents

have insurance through work or offered via the private insurance company. However, if the

parent lacks insurance, they will have to cover the child's health care fees out of their pocket. A

parent may apply for medical assistance via Medicaid. However, Medicaid is only covered as

long as the family meets the low-income bracket. Moreover, access to health care for children is

primarily state-run by private insurance for unemployed and disabled individuals. Also,

Medicaid covers low-income and disabled individuals and children, too (Kaminski, 2016).

People who are retired in the United States are covered in the following way: Generally,

after 62 years, they become eligible to get Medicare. However, Medicare does not cover all

costs; it is also used as secondary insurance even if an individual might be having private

insurance, retired from the military, and get the benefits that include healthcare coverage.

The employer may cover healthcare in the United States. The insurance cost is solely

based on the company that an individual works for and the insurance company. A child is

covered under the parent work. If an individual is self-employed, he/she has to find affordable

insurance. Private insurance can be costly. The is government assistance that is available like

Medicaid and Medicare.

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Unemployed people in the United Stated- Usually, unemployed people are not covered in

the United States. Unemployed individuals have to meet the low-income bracket to get

government assistance; otherwise, they have to meet the healthcare cost from their pocket

(Kaminski, 2016). Generally, the majority of the population is covered by privately pain

insurance companies. However, the employers retired as well as low-income families may

benefit from Medicaid.

Great Britain has an easy access healthcare system; the government is responsible for

running the health care system. In Great Britain, insurance is mandatory/ compulsory, and it is

also accessible. Whether unemployed, child or retired, every individual is permitted to sign up

for coverage. The N.H.S has made health care available to all individuals in the United States.

The N.H.S covers the children, unemployed individuals, and elderly individuals (Kaminski,

2016). The national health care service in Great Britain is entirely free and offered by the taxes

paid by citizens. The government usually allocates funds for the Hospitals, and the funds help to

cover the care cost.

Therefore, a comparison of access between the healthcare system of the U.S and Great

Britain for children, unemployed people, and people who are retired is that Great Britain has a

very accessible healthcare system for these group of people as compared to the United States,

A2A. Coverage of Medications

In Great Britain, there are copayments for the medications that are prescribed in the

outpatient clinics. However, among the children who are below age 16, full-time students within

age 16-18, the low-income people, the older adults, pregnant women, the individuals who have

had a kid over the last 12 months, cancer patients, among other illnesses including disabilities,

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the copayments do not hold/are suspended. Britain has 8.60 pounds per product-specific charge

in effect, an3-month prepaid care goes at 29.10 pounds. The U.K.'s National Health Service buys

drugs for the whole countries supply.

In the U.S, individual insurance groups and plans negotiate their prices with

pharmaceuticals, resulting in an unregulated pricing variety. Medication coverage is commonly

incorporated in the insurance plan by insurance companies. As far as the drugs are concerned,

the insurance plans have various copayments with various payment rates depending on the

medicine. The government has lower-cost choices for low incomes, children as well as elderly

individuals. According to the law perspective, Medicare can't negotiate with the pharmaceutical

companies (considered the largest purchaser of prescription drugs). Prescription Patient

assistance programs are available to unemployed individuals in the United States. However, if it

is not approved, then the patient may miss the needed medications.

A2B. Referral to See a Specialist

In Great Britain, any person is entitled to ask for a specialist treatment referral on the

N.H.S. However, whether an individual will receive the referral depends on what a person's G.P.

feels is clinically necessary in his/her case. If an individual wish to get referred to a specialist,

he/she has to see the G.P. they are registered with. The G.P understands the health history and

treatment of an individual much better. Additionally, the general practitioner determines if it is

clinically necessary for an individual to see the specialist. Before the specialist meets to know the

patient, such a patient should have a letter of reference from the general practitioner; this letter is

essential because it will give the specialist important background information, such as the

patient's medical history. Moreover, the general practitioner might advise the patient to try a

diverse treatment option to determine whether his/her condition is improving first. In Great

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Britain, an individual cannot self-refer to the specialist within the N.H.S. unless such an

individual is seeking sexual health clinics as well as A& E treatment.

In the United States, referrals are more complicated ("Referrals for specialist care,"

2018). to get a referral to a specialist in the U.S depends on the insurance. For instance, in the

Health Maintenance Organization, a person can only be referred to the specialists in the network.

The individual is required to have a referral depending on what specialist to see in the network.

In addition to this, the Preferred Provider Organization (P.P.O.) permits a person to see any

specialist they want without a referral as long as the insurance is covered in that specific facility.

In the United States, a person who is not insured requires a referral to see a specialist. The entire

costs have to be met by the person unless such an individual has government assistance. This

situation is similar to the child, unemployed individuals, and retired individuals.

A2C. Coverage for Preexisting Conditions

In the United States, Health insurers can no longer charge more or deny coverage to

individuals due to preexisting health condition. Health insurers can't limit the benefits because of

the preexisting condition. If a person has the insurance, health insurers can't refuse to cover the

treatment for an individual with a preexisting condition. However, suppose an individual lacks

insurance, and such a person has a preexisting condition. In that case, the physician can't refuse

to attend to or see such a person based on the Affordable Healthcare Act. However, in such a

situation, the cost has to be covered entirely by the person.

In the United Kingdom (U.K.), the insurers usually subscribe to the policies. This ensures

that the policy cannot cover the preexisting medical conditions that an individual might be

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having until the end of the designed period (Baggott, 1998). However, Private Health Insurance

in the United States has been designed to cover preexisting conditions (Goodman, 1980).

A3. Finance Implications for Healthcare Delivery

The high cost of healthcare in the United States will compel individuals to take out loans

and accrue debt to pay for the healthcare cost, especially those who are not insured and

unemployed. The high healthcare cost makes many individuals fail to afford health insurance,

and as a result, they remain uninsured. Patients requiring lengthy treatment are forced to accrue

debts and loans to pay for the bills since most insurance companies don't want to cover extended

hospital stays.

Secondly, the high healthcare cost in the United States hurts the savings of the patients,

the patients will spend a lot to meet the expenses, and this means they are not likely to save, and

this will have an adverse implication on the financial stability of the patient even resulting in

bankruptcy. The Safety net is affected significantly, mainly because any person without

insurance and government assistance has to fully (100%) meet the healthcare cost (Patti &

Fisichella, 2017).

In Great Britain, the National Health Services facilitates the coverage for healthcare

costs. This ensures that healthcare costs are very low. The patient is unlikely to take out loans

and accrue debts to settle the expenses. However, the implications of this are the quality of the

treatment provided to the patients (Frayer,2018). Another implication of this type of healthcare

system is the treatment timeliness; patients are likely to experience long waiting times hence

delayed treatment that can jeopardize the lives of the patients, especially those in critical

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conditions. The long waiting list is expected to prevent individuals, especially those with critical

chronic illness, from seeking immediate treatment (Baggott, 1998).

References

Baggott, R. (1998). The British health care system today. Health and Health Care in Britain,

105-131. doi:10.1007/978-1-349-14492-1_5

Goodman, J. C. (1980). National health care in Great Britain: Lessons for the U.S.A. Fisher

Inst.

Kaminski, M. (2016, October 31). British vs American health care, through one trainee doctor's

eyes. Retrieved from https://www.wbur.org/commonhealth/2016/10/31/american-british-

health-care

Patti, M. G., & Fisichella, P. M. (2017). The American health care system: A practical guide for

foreign medical graduates who want to enter the system. Springer.

Referrals for specialist care. (2018, August 14). Retrieved from https://www.nhs.uk/using-the-

nhs/nhs-services/gps/referrals-for-specialist-care/

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