The US and the Germany Healthcare System

Introduction

The American healthcare system is characterized by different programs that provide medical cover to different citizens. Small children can be covered by the Children’s Health Insurance Program. However, CHIP provides “coverage to children in specific families that qualify for Medicaid” (McDonough, 2015, p. 42). Eligible children benefit from emergency services, dental care, immunizations, and checkups. Consequently, many children from minority groups and backgrounds do not have medical cover. In the recent past, the Children’s Defense Fund (CDF) has been liaising with CHIP to cover more children. The unemployed members of society can get medical insurance plans from different providers in the marketplace (McDonough, 2015). Some unemployed citizens can qualify for Medicaid’s low-cost medical cover. Retirees have the option to buy the most suitable insurance plans from the marketplace. A small percentage of retirees are covered by the nation’s health care law (Altman, 2015).

The situation is quite different in Germany. This country is known to have universal coverage for its citizens. Children of employees in the country have medical cover. This means that such children are covered until they are able to make money (U.S. National Library of Health, 2015). Disabled children can be insured through their guardians and parents until they are able to take care of themselves. The other interesting aspect of Germany’s healthcare system is that it provides statutory medical insurance to retired and unemployed persons. This bracket also includes individuals who earn little money annually.

Coverage for Medications

Pharmaceuticals play a significant role in the healthcare delivery system. Adequate and timely access to medications is a critical strategy towards supporting the wellbeing of more citizens. The complexity of the United States’ healthcare system explains why more unemployed or low-income families are forced to incur huge medical expenses. Many Americans with medical cover use their incomes to purchase drugs. Individuals with Medicare coverage also incur more expenses (McDonough, 2015). This problem explains why President Obama’s Affordable Care Act (ACA) was aimed at making prescription coverage a critical aspect of health insurance in the country (McDonough, 2015). Policymakers have been focusing on new measures to expand medical coverage. This means that the coverage for medication under the U.S. healthcare system is unaffordable and unsustainable.

On the other hand, Germany has a sustainable system whereby prescription drugs are covered by the existing statutory insurance programs. The health insurance plans also cover treatments such as speech therapy, provision of hearing equipment, and prosthetic devices (U.S. National Library of Health, 2015). The citizens are only required to pay a small percentage of the expenses. The expenses incurred by patients in the country whenever acquiring drugs are small, depending on their insurance plans. Citizens who make special treatment requests are usually required to pay for the drugs and services. Children below the age of eighteen are not required to cater for the additional expenses. The concept of universality in Germany has led to a sustainable healthcare system that supports the needs of more people (U.S. National Library of Health, 2015). The level of equity in Germany’s pharmaceutical coverage can be borrowed by the United States in order to improve its healthcare system.

Requirements to Get a Referral

The American healthcare system allows patients to get a referral to see a specialist. However, several requirements should be met in order to be referred to a medical expert. To begin with, the patient in question should have a condition that cannot be treated successfully by his or her primary doctor. The individual will have to get a written form (or order) from the primary care provider (Altman, 2015). This order is used in order to get advanced medical care or support. Many healthcare organizations in the nation provide medical care to patients who have been referred by their primary care doctors. The health services received by citizens who fail to get the referral may not be covered by their insurance plans. However, some services such as annual mammograms do not require any referral.

In Germany, physicians can refer their patients to get advanced medical support. This takes place when the patient’s physician is unable to offer the required health care (U.S. National Library of Health, 2015). Citizens are usually required to present their health insurance cards whenever they visit the targeted hospital. This means that a written order is not provided by the physician. Individuals visiting private practitioners are required to cater to their medical expenses.

Coverage for Preexisting Conditions

Before 30th April 2014, the American healthcare system supported the Preexisting Condition Insurance Plan (PCIP) that provided insurance options to persons who lacked medical cover and had a preexisting health condition (Altman, 2015). The program also covered individuals who had been unable to get appropriate cover. This program was then replaced under the ACA. Presently, the country’s insurance plan for health does not deny coverage for various preexisting conditions (Altman, 2015). This means that PCIP enrollees have found it easier to transition to new insurance covers.

The coverage for such conditions is quite different under Germany’s healthcare system. In this country, people who have preexisting health conditions are usually required to pay more money than their healthy counterparts (U.S. National Library of Health, 2015). Older people with various conditions also incur more expenses than younger ones. A person’s premium in Germany increases with age. Medical cover is also available to all people regardless of their medical conditions. Preexisting conditions are, therefore, “considered as non-problems in the country” (U.S. National Library of Health, 2015, para. 14).

Two Financial Implications for Patients

In the United States, patients have to deal with numerous financial challenges arising from the country’s healthcare system. The first financial implication is that patients in the nation are forced to “spend two times as much on out-of-pocket medical expenses compared to individuals in other developed nations” (McDonough, 2015, p. 47). The complexity of the healthcare delivery process forces patients to incur numerous expenses in every treatment stage. They are also required to purchase drugs from different pharmacies or dealers.

The healthcare system implemented in Germany presents various financial implications for the patient. To begin with, every insured citizen must pay around 8.2 percent of his or her income to cater for the health cover. This is also the same case for unemployed persons because they have to part with a percentage of their unemployment benefits or entitlements (U.S. National Library of Health, 2015). The second implication is that patients will not have to pay for different services such as gum treatment, physiotherapy, checkups, and prescription drugs. This means that more patients can receive quality health care without incurring numerous financial costs.

References

Altman, D. (2015). Public vs. private health insurance on controlling spending. The Wall Street Journal. Web.

McDonough, J. (2015). The United States health system in transition. Health Systems & Reform, 1(1), 39-51.

U.S. National Library of Health. (2015). Health care in Germany: Health insurance in Germany. PubMed Health, 1(1), 1-12.